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General NPI Number Information
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NPI Number | 1740639988
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Entity Type | Organization
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Legal Business Name | BUCKEYE DENTAL CARE LLC.
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Dates
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Enumeration Date | 06/08/2016
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Last Update Date | 06/08/2016
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Provider Practice Location Address
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Address Line | 1268 OHIO PIKE
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City | AMELIA
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State | OH
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Zip | 45102
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Country | US
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Telephone | 513-482-0005
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Fax |
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Provider Business Mailing Address
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Address Line | 1268 OHIO PIKE
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City | AMELIA
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State | OH
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Zip | 45102
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Country | US
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Telephone | 513-482-0005
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Fax |
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Authorized Official
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Title or Position | DENTIST
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Name | GHULAM FAREED
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Credential | DDS.
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Telephone | 513-482-0005
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 305S00000X
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Taxonomy Name | Point of Service
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License Number | 30.021441
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License Number State | OH
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