Healthcare Provider Details

I. General information

NPI: 1316021389
Provider Name (Legal Business Name): DEANI L DESKINS-KNEBEL DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/25/2006
Last Update Date: 12/20/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

240 PARSONS AVE
COLUMBUS OH
43215-5331
US

IV. Provider business mailing address

PO BOX 16370
COLUMBUS OH
43216-6370
US

V. Phone/Fax

Practice location:
  • Phone: 614-645-6251
  • Fax: 614-645-7080
Mailing address:
  • Phone: 614-645-5500
  • Fax: 614-645-5517

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number30-01-9708
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number30019708
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: