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NPI Code Detail

MEDICARE: MY FAMILY DENTAL

MEDICARE: MY FAMILY DENTAL
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
1261QD0000XDental Clinic/Center30022270OH

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
11871652495OTHEROHINDIVIDUAL NPI
21821011701OTHEROHINDIVIDUAL NPI

General Provider Information

NPI Number : 1295019115
Entity Type Code : Organization
Provider Name (Legal Business Name) : MY FAMILY DENTAL
Provider Business Mailing Address
First Line : 4110 BUCKEYE PKWY
Second Line :
City : GROVE CITY
State : OH
Zip : 43123-8175
Country : US
Telephone Number : 614-539-0765
Fax Number : 614-522-6767
Provider Business Practice Location Address
First Line : 4110 BUCKEYE PKWY
Second Line :
City : GROVE CITY
State : OH
Zip : 43123-8175
Country : US
Telephone Number : 614-539-0765
Fax Number : 614-522-6767
Authorized Official
Title or Position : OWNER
Name : DR. MICHAEL LEE SMITH JR.
Credential : DDS
Telephone Number : 614-759-4746
Provider Enumeration Date : 10/11/2011
Last Update Date : 10/11/2011

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Directions to “MY FAMILY DENTAL ” Practice Location

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These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.