MEDICARE: GROVE CITY FAMILY DENTISTRY INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	30019188	OH
2	122300000X	Dentist	30021400	OH
3	122300000X	Dentist	30020068
4	122300000X	Dentist	30020557	OH

General Provider Information

NPI Number	:	1134215353
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GROVE CITY FAMILY DENTISTRY INC

Provider Business Mailing Address
First Line	:	3031 COLUMBUS STREET
Second Line	:
City	:	GROVE CITY
State	:	OH
Zip	:	43123
Country	:	US
Telephone Number	:	614-875-2153
Fax Number	:	614-871-7471

Provider Business Practice Location Address
First Line	:	3031 COLUMBUS STREET
Second Line	:
City	:	GROVE CITY
State	:	OH
Zip	:	43123
Country	:	US
Telephone Number	:	614-875-2153
Fax Number	:	614-871-7471

Authorized Official
Title or Position	:	OWNER
Name	:	MR. CRAIG DANIEL OILER
Credential	:	DDS
Telephone Number	:	614-875-2153

Provider Enumeration Date	:	10/05/2006
Last Update Date	:	08/22/2020

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