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NPI Code Detail

MEDICARE: KEEP SMILING DENTAL GROUP DRS. RODDY & PALM LLC

MEDICARE: KEEP SMILING DENTAL GROUP DRS. RODDY & PALM LLC
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
1122300000XDentist

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
11013089770OTHERNPPES
230.019043OTHEROHOHIO STATE DENTAL BOARD
31376034488OTHERNPPES
430.025388OTHEROHOHIO STATE DENTAL BOARD

General Provider Information

NPI Number : 1710562251
Entity Type Code : Organization
Provider Name (Legal Business Name) : KEEP SMILING DENTAL GROUP DRS. RODDY & PALM LLC
Provider Business Mailing Address
First Line : 4090 INDIAN RIPPLE RD STE 101
Second Line :
City : BEAVERCREEK
State : OH
Zip : 45440-3292
Country : US
Telephone Number : 937-426-5340
Fax Number :
Provider Business Practice Location Address
First Line : 4090 INDIAN RIPPLE RD STE 101
Second Line :
City : BEAVERCREEK
State : OH
Zip : 45440-3292
Country : US
Telephone Number : 937-426-5340
Fax Number :
Authorized Official
Title or Position : BUSINESS MANAGER
Name : SUE RADER
Credential :
Telephone Number : 937-426-5340
Provider Enumeration Date : 03/16/2021
Last Update Date : 03/16/2021

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Directions to “KEEP SMILING DENTAL GROUP DRS. RODDY & PALM LLC ” Practice Location

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