Healthcare Provider Details

I. General information

NPI: 1811095276
Provider Name (Legal Business Name): DAVD BRADLEY KRILL D.M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10475 MONTGOMERY RD STE 1H
CINCINNATI OH
45242-5200
US

IV. Provider business mailing address

10475 MONTGOMERY RD STE 1H
CINCINNATI OH
45242-5200
US

V. Phone/Fax

Practice location:
  • Phone: 513-891-3933
  • Fax: 513-891-5979
Mailing address:
  • Phone: 513-891-3933
  • Fax: 513-891-5979

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number16364
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: