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General NPI Number Information
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NPI Number | 1578901229
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Entity Type | Organization
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Legal Business Name | KENNY ROAD FAMILY DENTAL
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Dates
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Enumeration Date | 06/04/2013
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Last Update Date | 06/04/2013
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Provider Practice Location Address
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Address Line | 4589 KENNY RD SUITE 201
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City | COLUMBUS
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State | OH
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Zip | 43220-2770
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Country | US
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Telephone | 614-451-2727
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Fax | 614-451-8177
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Provider Business Mailing Address
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Address Line | 4589 KENNY ROAD SUITE 201
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City | COLUMBUS
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State | OH
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Zip | 43220
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Country | US
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Telephone | 614-451-2727
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Fax | 614-451-8177
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Authorized Official
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Title or Position | OWNER
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Name | DR. ROBERT E GARRISON
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Credential |
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Telephone | 614-451-2727
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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 | 30016420
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License Number State | OH
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