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General NPI Number Information
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NPI Number | 1700162146
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Entity Type | Organization
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Legal Business Name | 1151 S HIGH ST DENTISTS GROUP
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Dates
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Enumeration Date | 10/31/2011
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Last Update Date | 10/31/2011
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Provider Practice Location Address
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Address Line | 1151 S HIGH ST
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City | COLUMBUS
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State | OH
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Zip | 43206-3434
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Country | US
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Telephone | 614-725-5688
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Fax | 614-725-5692
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Provider Business Mailing Address
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Address Line | 1151 S HIGH ST
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City | COLUMBUS
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State | OH
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Zip | 43206-3434
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Country | US
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Telephone | 614-725-5688
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Fax | 614-725-5692
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Authorized Official
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Title or Position | OWNER
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Name | DR. DAVID KERSCHNER
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Credential | D.D.S
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Telephone | 614-725-5688
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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 | 30016761
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License Number State | OH
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