Healthcare Provider Details

I. General information

NPI: 1932880978
Provider Name (Legal Business Name): ELAINE PLATT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/31/2023
Last Update Date: 10/03/2024
Certification Date: 10/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40 E MCMICKEN AVE
CINCINNATI OH
45202-6625
US

IV. Provider business mailing address

40 E MCMICKEN AVE
CINCINNATI OH
45202-6625
US

V. Phone/Fax

Practice location:
  • Phone: 513-386-7899
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number30.027323
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: