Healthcare Provider Details

I. General information

NPI: 1366092587
Provider Name (Legal Business Name): NEISSA BENDER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/19/2019
Last Update Date: 09/19/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

612 ROCKDALE AVE
CINCINNATI OH
45229-2919
US

IV. Provider business mailing address

3101 BURNET AVE
CINCINNATI OH
45229-3014
US

V. Phone/Fax

Practice location:
  • Phone: 513-352-4072
  • Fax: 513-352-4075
Mailing address:
  • Phone: 513-357-7383
  • Fax: 513-357-7385

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code126800000X
TaxonomyDental Assistant
License Number51.011877
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: