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General NPI Number Information
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NPI Number | 1619391984
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Entity Type | Organization
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Legal Business Name | TAYLORSVILLE FAMILY DENTAL
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Dates
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Enumeration Date | 02/07/2014
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Last Update Date | 02/07/2014
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Provider Practice Location Address
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Address Line | 7212 TAYLORSVILLE RD
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City | HUBER HEIGHTS
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State | OH
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Zip | 45424-2303
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Country | US
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Telephone | 937-233-6500
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Fax | 937-233-6500
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Provider Business Mailing Address
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Address Line | 7212 TAYLORSVILLE RD
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City | HUBER HEIGHTS
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State | OH
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Zip | 45424-2303
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Country | US
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Telephone | 937-233-6500
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Fax | 937-233-6500
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Authorized Official
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Title or Position | FRONT DESK
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Name | JUSTINE BEATTY
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Credential |
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Telephone | 937-233-6500
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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 | 20761
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License Number State | OH
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