Healthcare Provider Details

I. General information

NPI: 1013526078
Provider Name (Legal Business Name): ATHENS DENTAL DEPOT, MICHAEL D. GINDER DDS & COMPANY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/27/2020
Last Update Date: 07/27/2020
Certification Date: 07/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

80 COLUMBUS RD
ATHENS OH
45701-1312
US

IV. Provider business mailing address

80 COLUMBUS RD
ATHENS OH
45701-1312
US

V. Phone/Fax

Practice location:
  • Phone: 740-594-6000
  • Fax: 740-594-6025
Mailing address:
  • Phone: 740-594-6000
  • Fax: 740-594-6025

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: ANNE CORNWELL
Title or Position: TREASURER/CPA
Credential:
Phone: 740-707-7838