Healthcare Provider Details

I. General information

NPI: 1861504599
Provider Name (Legal Business Name): DHO-RONALD STANICH DDS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 07/30/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

123 S. SECOND STREET
LOVELAND OH
45140-0097
US

IV. Provider business mailing address

PO BOX 97
LOVELAND OH
45140-0097
US

V. Phone/Fax

Practice location:
  • Phone: 513-774-8152
  • Fax: 513-774-8154
Mailing address:
  • Phone: 513-774-8152
  • Fax: 513-774-8154

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number30015519
License Number StateOH

VIII. Authorized Official

Name: MR. TIMOTHY J HOLLAND
Title or Position: MANAGER
Credential:
Phone: 513-774-8152