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General NPI Number Information
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NPI Number | 1285445288
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Entity Type | Organization
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Legal Business Name | 614 DENTAL GROUP
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Dates
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Enumeration Date | 01/17/2025
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Last Update Date | 01/17/2025
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Provider Practice Location Address
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Address Line | 81 S 4TH ST STE 205
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City | COLUMBUS
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State | OH
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Zip | 43215-4308
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Country | US
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Telephone | 614-588-8200
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Fax |
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Provider Business Mailing Address
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Address Line | 2028 FLORAL AVE
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City | COLUMBUS
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State | OH
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Zip | 43223-1106
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Country | US
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Telephone | 614-632-3150
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Fax |
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Authorized Official
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Title or Position | OWNER / OFFICE MANAGER
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Name | TARA HERMAN
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Credential |
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Telephone | 614-632-3150
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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 |
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License Number State |
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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 |
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License Number State |
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