Healthcare Provider Details

I. General information

NPI: 1457280679
Provider Name (Legal Business Name): KEMAL SARVALOV
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/14/2026
Last Update Date: 05/14/2026
Certification Date: 05/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8881 GOVERNORS HILL DR
CINCINNATI OH
45249-1337
US

IV. Provider business mailing address

6764 RIVULET DR
MIDDLETOWN OH
45042-3176
US

V. Phone/Fax

Practice location:
  • Phone: 513-912-3100
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number30.028459
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number30.028459
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: