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General NPI Number Information
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NPI Number | 1376000224
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Entity Type | Organization
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Legal Business Name | KIDSMILES PEDIATRIC DENTAL CLINIC
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Dates
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Enumeration Date | 02/27/2019
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Last Update Date | 03/05/2019
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Provider Practice Location Address
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Address Line | 770 BETHEL RD
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City | COLUMBUS
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State | OH
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Zip | 43214-1900
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Country | US
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Telephone | 614-458-1711
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Fax | 614-458-1713
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Provider Business Mailing Address
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Address Line | 770 BETHEL RD
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City | COLUMBUS
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State | OH
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Zip | 43214-1900
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Country | US
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Telephone | 614-458-1711
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Fax | 614-458-1713
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MRS. LAURA NICOLE ZUBER
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Credential |
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Telephone | 614-458-1711
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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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