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General NPI Number Information
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NPI Number | 1447732961
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Entity Type | Organization
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Legal Business Name | PRIMEHEALTH OF OHIO LLC
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Dates
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Enumeration Date | 08/31/2018
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Last Update Date | 08/31/2018
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Provider Practice Location Address
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Address Line | 20 S 3RD ST STE 210
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City | COLUMBUS
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State | OH
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Zip | 43215-4206
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Country | US
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Telephone | 844-882-3127
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Fax |
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Provider Business Mailing Address
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Address Line | 2100 E LAKE COOK RD STE 1000
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City | BUFFALO GROVE
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State | IL
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Zip | 60089-1999
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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 | DELEGATED OFFICIAL
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Name | PAMELA B DEVAULT
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Credential |
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Telephone | 224-632-5613
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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 |
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License Number State |
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