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General NPI Number Information
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NPI Number | 1134467145
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Entity Type | Organization
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Legal Business Name | ARCH CITY DENTAL, LLC
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Dates
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Enumeration Date | 01/25/2013
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Last Update Date | 01/04/2016
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Provider Practice Location Address
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Address Line | 6343 PRESIDENTIAL GATEWAY SUITE 100
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City | COLUMBUS
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State | OH
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Zip | 43231
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Country | US
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Telephone | 614-891-7075
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Fax | 614-891-6033
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Provider Business Mailing Address
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Address Line | 6343 PRESIDENTIAL GATEWAY SUITE 100
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City | COLUMBUS
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State | OH
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Zip | 43231
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Country | US
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Telephone | 614-891-7075
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Fax | 614-891-6033
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Authorized Official
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Title or Position | OWNER
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Name | DR. BRUCE C. BALOY
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Credential | DDS
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Telephone | 614-891-7075
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 20715
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 15684
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License Number State | OH
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