=====================================================
General NPI Number Information
=====================================================
NPI Number | 1730999194
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DENTAL ASSOCIATES OF WEST CHESTER, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/08/2025
-----------------------------------------------------
Last Update Date | 01/08/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9215 CINCINNATI COLUMBUS RD STE 2
-----------------------------------------------------
City | WEST CHESTER
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45069-4178
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 513-777-5513
-----------------------------------------------------
Fax | 513-777-7157
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 9215 CINCINNATI COLUMBUS RD STE 2
-----------------------------------------------------
City | WEST CHESTER
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45069-4178
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 513-777-5513
-----------------------------------------------------
Fax | 513-777-7157
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. DAVID J MANEGOLD
-----------------------------------------------------
Credential | D.M.D.
-----------------------------------------------------
Telephone | 513-777-5513
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------