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General NPI Number Information
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NPI Number | 1306216247
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Entity Type | Organization
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Legal Business Name | WINCHESTER DENTAL LLC
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Dates
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Enumeration Date | 10/05/2015
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Last Update Date | 10/05/2015
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Provider Practice Location Address
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Address Line | 6418 WINCHESTER BLVD
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City | CANAL WINCHESTER
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State | OH
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Zip | 43110-2005
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Country | US
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Telephone | 614-834-1834
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Fax |
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Provider Business Mailing Address
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Address Line | 6418 WINCHESTER BLVD
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City | CANAL WINCHESTER
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State | OH
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Zip | 43110-2005
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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 | OWNER
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Name | LADAN POURMOGHADAM
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Credential | DDS
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Telephone | 614-506-0740
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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 | 30018271
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License Number State | OH
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