Healthcare Provider Details

I. General information

NPI: 1063326460
Provider Name (Legal Business Name): PARK DENTAL PLAIN CITY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/01/2026
Last Update Date: 10/01/2026
Certification Date: 10/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 S JEFFERSON AVE
PLAIN CITY OH
43064-4137
US

IV. Provider business mailing address

500 S JEFFERSON AVE
PLAIN CITY OH
43064-4137
US

V. Phone/Fax

Practice location:
  • Phone: 614-733-0800
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number StateNULL

VIII. Authorized Official

Name: SIDDHI PATEL
Title or Position: OWNER
Credential: DDS
Phone: 614-890-0510