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General NPI Number Information
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NPI Number | 1699283523
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Entity Type | Individual
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Provider Name | MARC ALLEN KANETSKY DDS
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Gender | Male
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Dates
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Enumeration Date | 01/12/2018
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Last Update Date | 01/12/2018
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Provider Practice Location Address
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Address Line | 1445 N MAIN AVE
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City | SIDNEY
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State | OH
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Zip | 45365-1782
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Country | US
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Telephone | 937-492-9983
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Fax |
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Provider Business Mailing Address
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Address Line | 374 CENTER ST
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City | HUBBARD
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State | OH
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Zip | 44425-1546
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Country | US
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Telephone | 330-301-0768
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 30.025289
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License Number State | OH
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