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General NPI Number Information
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NPI Number | 1194915991
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Entity Type | Individual
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Provider Name | JANA MARIE IMPERIAL D.D.S.
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Gender | Female
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Dates
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Enumeration Date | 07/27/2007
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Last Update Date | 04/07/2009
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Provider Practice Location Address
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Address Line | 11333 SPRINGFIELD PIKE
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City | CINCINNATI
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State | OH
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Zip | 45246-4201
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Country | US
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Telephone | 513-772-0722
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Fax |
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Provider Business Mailing Address
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Address Line | 10 N CHERRY ST APT. 2
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City | LEBANON
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State | OH
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Zip | 45036-2481
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Country | US
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Telephone | 614-296-2766
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 30-022566
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License Number State | OH
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