MEDICARE: TAYLORSVILLE 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
1	1223G0001X	General Practice Dentistry	20761	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1619391984
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TAYLORSVILLE FAMILY DENTAL

Provider Business Mailing Address
First Line	:	7212 TAYLORSVILLE RD
Second Line	:
City	:	HUBER HEIGHTS
State	:	OH
Zip	:	45424-2303
Country	:	US
Telephone Number	:	937-233-6500
Fax Number	:	937-233-6500

Provider Business Practice Location Address
First Line	:	7212 TAYLORSVILLE RD
Second Line	:
City	:	HUBER HEIGHTS
State	:	OH
Zip	:	45424-2303
Country	:	US
Telephone Number	:	937-233-6500
Fax Number	:	937-233-6500

Authorized Official
Title or Position	:	FRONT DESK
Name	:	JUSTINE BEATTY
Credential	:
Telephone Number	:	937-233-6500

Provider Enumeration Date	:	02/07/2014
Last Update Date	:	02/07/2014

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Directions to “TAYLORSVILLE FAMILY DENTAL ” Practice Location

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