Healthcare Provider Details
I. General information
NPI: 1013060540
Provider Name (Legal Business Name): CINCYSMILES FOUNDATION
Entity Type: Organization
Gender:
Sole Proprietor:
II. Dates (important events)
Enumeration Date: 01/19/2007
Last Update Date: 08/05/2013
Certification Date:
Deactivation Date:
Reactivation Date:
III. Provider practice location address
635 W 7TH ST SUITE 405
CINCINNATI OH
45203-1513
US
IV. Provider business mailing address
635 W 7TH ST SUITE 405
CINCINNATI OH
45203-1513
US
V. Phone/Fax
- Phone: 513-621-0248
- Fax: 513-621-0288
- Phone: 513-621-0248
- Fax: 513-621-0288
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 1223D0001X |
| Taxonomy | Public Health Dentistry |
| License Number | |
| License Number State | |
VIII. Authorized Official
Name: DR.
LAWRENCE
F
HILL
Title or Position: EXECUTIVE DIRECTOR
Credential: DDS,MPH
Phone: 513-621-0248