Healthcare Provider Details

I. General information

NPI: 1801063102
Provider Name (Legal Business Name): COSMETIC AND IMPLANT DENTAL CENTER OF CINCINNATI, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/15/2008
Last Update Date: 05/15/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

910 BARRY LN
CINCINNATI OH
45229-1743
US

IV. Provider business mailing address

910 BARRY LN
CINCINNATI OH
45229-1743
US

V. Phone/Fax

Practice location:
  • Phone: 513-281-2333
  • Fax: 513-281-4902
Mailing address:
  • Phone: 513-281-2333
  • Fax: 513-281-4902

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number StateOH

VIII. Authorized Official

Name: JACK A HAHN
Title or Position: OWNER
Credential: DDS
Phone: 513-281-2333