MEDICARE: COMMUNITY ORTHODONTIC CARE

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	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	17256	OH

General Provider Information

NPI Number	:	1609096619
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COMMUNITY ORTHODONTIC CARE

Provider Business Mailing Address
First Line	:	10535 MONTGOMERY RD
Second Line	:	SUITE 100
City	:	CINCINNATI
State	:	OH
Zip	:	45242-4448
Country	:	US
Telephone Number	:	513-791-9336
Fax Number	:	513-791-8015

Provider Business Practice Location Address
First Line	:	10535 MONTGOMERY RD
Second Line	:	SUITE 100
City	:	CINCINNATI
State	:	OH
Zip	:	45242-4448
Country	:	US
Telephone Number	:	513-791-9336
Fax Number	:	513-791-8015

Authorized Official
Title or Position	:	DENTIST
Name	:	DR. ERIC M ORNELLA
Credential	:	D.D.S., M.S.D.
Telephone Number	:	513-791-9336

Provider Enumeration Date	:	05/01/2007
Last Update Date	:	08/22/2020

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