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General NPI Number Information
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NPI Number | 1528726445
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Entity Type | Organization
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Legal Business Name | GROVE CITY PEDIATRIC DENTISTRY
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Dates
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Enumeration Date | 12/08/2021
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Last Update Date | 12/08/2021
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Provider Practice Location Address
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Address Line | 5775 HOOVER RD STE B
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City | GROVE CITY
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State | OH
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Zip | 43123-7693
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Country | US
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Telephone | 614-350-5005
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Fax | 614-350-5070
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Provider Business Mailing Address
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Address Line | 40 W SHORT ST
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City | WORTHINGTON
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State | OH
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Zip | 43085-3561
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Country | US
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Telephone | 402-968-2007
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Fax | 614-459-0883
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Authorized Official
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Title or Position | OWNER/MEMBER
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Name | DR. KYLE BEULKE
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Credential | DDS
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Telephone | 402-968-2007
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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 |
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License Number State |
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