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General NPI Number Information
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NPI Number | 1063929487
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Entity Type | Organization
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Legal Business Name | FAMILY ORTHODONTICS OF OHIO JIM SHEALY DDS LLC
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Dates
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Enumeration Date | 01/08/2018
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Last Update Date | 01/08/2018
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Provider Practice Location Address
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Address Line | 4440 LINDEN AVE
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City | DAYTON
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State | OH
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Zip | 45432-3031
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Country | US
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Telephone | 937-252-8651
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Fax |
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Provider Business Mailing Address
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Address Line | 1350 SPRING ST NW STE 600
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City | ATLANTA
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State | GA
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Zip | 30309-2870
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CREDENTIALING SPECIALIST
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Name | TAMONIA LEONARD
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Credential |
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Telephone | 678-244-4844
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number |
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License Number State |
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