Healthcare Provider Details

I. General information

NPI: 1659086049
Provider Name (Legal Business Name): DENTISTRY FOR CHILDREN OF OHIO 2 RANDY HAMILTON DMD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/19/2023
Last Update Date: 06/28/2023
Certification Date: 06/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21590 CENTER RIDGE RD
ROCKY RIVER OH
44116-3945
US

IV. Provider business mailing address

2970 BRANDYWINE RD STE 200
ATLANTA GA
30341-5549
US

V. Phone/Fax

Practice location:
  • Phone: 770-692-1000
  • Fax:
Mailing address:
  • Phone: 770-692-1000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JOANN RICE
Title or Position: CREDENTIALING MANAGER
Credential:
Phone: 609-315-3851