Healthcare Provider Details

I. General information

NPI: 1104091651
Provider Name (Legal Business Name): DENTAL SERVICES OF OHIO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/25/2008
Last Update Date: 04/12/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8340 COLERAIN AVE STE 1
CINCINNATI OH
45239-3916
US

IV. Provider business mailing address

PO BOX 11568
OVERLAND PARK KS
66207-4268
US

V. Phone/Fax

Practice location:
  • Phone: 513-385-5999
  • Fax: 913-800-6967
Mailing address:
  • Phone: 913-428-1674
  • Fax: 913-800-6967

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number30-018565
License Number StateOH

VIII. Authorized Official

Name: AMY WHEELER
Title or Position: CREDENTIALING COORDINATOR
Credential:
Phone: 913-800-6952