Healthcare Provider Details

I. General information

NPI: 1982529780
Provider Name (Legal Business Name): TRAILSIDE DENTAL PARTNERS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/11/2026
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5382 COX SMITH RD STE D
MASON OH
45040-6803
US

IV. Provider business mailing address

6598 WYNDWATCH DR
CINCINNATI OH
45230-5266
US

V. Phone/Fax

Practice location:
  • Phone: 513-229-7711
  • Fax:
Mailing address:
  • Phone: 720-822-3502
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: MR. CHAD MALENFANT
Title or Position: VICE PRESIDENT
Credential:
Phone: 720-822-3502