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General NPI Number Information
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NPI Number | 1225278971
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Entity Type | Organization
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Legal Business Name | SOUTHWESTERN OHIO DENTAL ASSOCIATES L.L.C.
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Dates
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Enumeration Date | 02/20/2009
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Last Update Date | 02/20/2009
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Provider Practice Location Address
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Address Line | 11740 HAMILTON AVE SUITE A
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City | CINCINNATI
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State | OH
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Zip | 45231-1255
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Country | US
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Telephone | 513-825-7570
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Fax | 513-825-7999
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Provider Business Mailing Address
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Address Line | 11740 HAMILTON AVE SUITE A
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City | CINCINNATI
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State | OH
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Zip | 45231-1255
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Country | US
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Telephone | 513-825-7570
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Fax | 513-825-7999
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Authorized Official
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Title or Position | SOLE PROPRIETER / OWNER
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Name | DR. GREGORY A MCDONALD
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Credential | D.D.S.
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Telephone | 513-825-7570
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 18367
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License Number State | OH
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