Healthcare Provider Details

I. General information

NPI: 1093817835
Provider Name (Legal Business Name): ATHENS DENTAL ARTS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/02/2006
Last Update Date: 10/11/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

207 N COLUMBUS ROAD
ATHENS OH
45701
US

IV. Provider business mailing address

207 N COLUMBUS ROAD
ATHENS OH
45701-1335
US

V. Phone/Fax

Practice location:
  • Phone: 740-593-8530
  • Fax: 740-594-2215
Mailing address:
  • Phone: 740-593-8530
  • Fax: 740-594-2215

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number20749
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number17938
License Number StateOH
# 3
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number14320
License Number StateOH

VIII. Authorized Official

Name: DR. ELIZABETH C WELSH
Title or Position: OWNER
Credential: DDS
Phone: 740-593-8530