=====================================================
General NPI Number Information
=====================================================
NPI Number | 1376862243
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | JEFF KOVER D.D.S. AND ASSOC, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/18/2010
-----------------------------------------------------
Last Update Date | 05/18/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 455 INDUSTRIAL MILE RD
-----------------------------------------------------
City | COLUMBUS
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43228-2482
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 614-428-0487
-----------------------------------------------------
Fax | 614-428-0650
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1375 CHERRY WAY DR #210
-----------------------------------------------------
City | GAHANNA
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43230-8700
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 614-428-0487
-----------------------------------------------------
Fax | 614-428-0650
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MANAGING PARTNER/DENTIST
-----------------------------------------------------
Name | DR. JEFF KOVER
-----------------------------------------------------
Credential | D.D.S.
-----------------------------------------------------
Telephone | 614-428-0487
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------