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General NPI Number Information
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NPI Number | 1568625184
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Entity Type | Organization
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Legal Business Name | MIDDLETOWN DENTAL ASSOCIATES
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Dates
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Enumeration Date | 07/03/2008
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Last Update Date | 07/03/2008
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Provider Practice Location Address
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Address Line | 2207 CENTRAL AVE
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City | MIDDLETOWN
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State | OH
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Zip | 45044-4603
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Country | US
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Telephone | 513-423-2351
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Fax | 513-423-5328
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Provider Business Mailing Address
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Address Line | 2207 CENTRAL AVE
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City | MIDDLETOWN
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State | OH
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Zip | 45044-4603
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Country | US
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Telephone | 513-423-2351
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Fax | 513-423-5328
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MRS. CHANDA KAY HEATER
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Credential |
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Telephone | 513-423-2351
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 022612
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License Number State | OH
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