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General NPI Number Information
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NPI Number | 1659643922
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Entity Type | Organization
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Legal Business Name | HYDE PARK PEDIATRIC DENTISTRY
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Dates
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Enumeration Date | 02/02/2012
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Last Update Date | 02/02/2012
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Provider Practice Location Address
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Address Line | 3870 PAXTON AVE SUITE G AND H
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City | CINCINNATI
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State | OH
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Zip | 45209-2366
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Country | US
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Telephone | 513-979-6998
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Fax | 513-979-6990
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Provider Business Mailing Address
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Address Line | 3870 PAXTON AVE SUITE G AND H
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City | CINCINNATI
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State | OH
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Zip | 45209-2366
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Country | US
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Telephone | 513-979-6998
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Fax | 513-979-6990
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Authorized Official
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Title or Position | OWNER/DENTIST
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Name | KATLIN BLOMER
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Credential |
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Telephone | 513-979-6998
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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 | 30.023390
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License Number State | OH
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