Healthcare Provider Details

I. General information

NPI: 1942640586
Provider Name (Legal Business Name): KIM M OBERLANDER DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2013
Last Update Date: 08/10/2020
Certification Date: 08/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1036 S VERITY PKWY
MIDDLETOWN OH
45044-5513
US

IV. Provider business mailing address

300 HIGH ST FL 3
HAMILTON OH
45011-6078
US

V. Phone/Fax

Practice location:
  • Phone: 513-454-1111
  • Fax:
Mailing address:
  • Phone: 513-454-1460
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223D0001X
TaxonomyPublic Health Dentistry
License Number30024018
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: