Healthcare Provider Details

I. General information

NPI: 1205584802
Provider Name (Legal Business Name): DANIEL HARRIS PRYWITCH DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/13/2022
Last Update Date: 05/25/2023
Certification Date: 05/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

234 GOODMAN ST
CINCINNATI OH
45219-2364
US

IV. Provider business mailing address

2761 ERIE AVE
CINCINNATI OH
45208-2240
US

V. Phone/Fax

Practice location:
  • Phone: 513-584-6660
  • Fax: 513-584-6661
Mailing address:
  • Phone: 513-321-0886
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number30.027178
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: