=====================================================
General NPI Number Information
=====================================================
NPI Number | 1427184894
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DENTAL ASSOCIATES LM SHELL DDS & WA RECORDS DDS INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/27/2007
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2862 E MAIN STREET
-----------------------------------------------------
City | COLUMBUS
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43209
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 614-235-3444
-----------------------------------------------------
Fax | 614-235-3495
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2862 E MAIN STREET
-----------------------------------------------------
City | COLUMBUS
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43209
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 614-235-3444
-----------------------------------------------------
Fax | 614-235-3495
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | TREASURER
-----------------------------------------------------
Name | DR. WILLIAM A RECORDS
-----------------------------------------------------
Credential | DDS
-----------------------------------------------------
Telephone | 614-235-3444
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------