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General NPI Number Information
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NPI Number | 1528282548
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Entity Type | Organization
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Legal Business Name | CHILDREN'S CLINIC OF COSHOCTON COUNTY, INC
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Dates
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Enumeration Date | 04/12/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 406 S 15TH ST
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City | COSHOCTON
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State | OH
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Zip | 43812-2285
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Country | US
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Telephone | 740-622-8421
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Fax |
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Provider Business Mailing Address
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Address Line | 406 S 15TH ST
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City | COSHOCTON
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State | OH
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Zip | 43812-2285
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Country | US
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Telephone | 740-622-8421
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Fax |
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Authorized Official
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Title or Position | CLINIC DIRECTOR
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Name | DR. BRIAN DUNLAP
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Credential | DDS
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Telephone | 740-622-8421
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 019143
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License Number State | OH
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