Healthcare Provider Details

I. General information

NPI: 1952647828
Provider Name (Legal Business Name): CENTRAL OHIO TMJD & DENTAL SLEEP THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/21/2012
Last Update Date: 11/16/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

149 W SCHROCK RD
WESTERVILLE OH
43081-2831
US

IV. Provider business mailing address

149 W SCHROCK RD
WESTERVILLE OH
43081-2831
US

V. Phone/Fax

Practice location:
  • Phone: 614-890-1571
  • Fax: 614-890-4518
Mailing address:
  • Phone: 614-890-1571
  • Fax: 614-890-4518

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number15998
License Number StateOH

VIII. Authorized Official

Name: DR. MICHAEL J BEZBATCHENKO
Title or Position: OWNER/DENTIST
Credential: DDS
Phone: 614-890-1571