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General NPI Number Information
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NPI Number | 1811333792
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Entity Type | Organization
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Legal Business Name | SPRINGFIELD PEDIATRIC DENTISTRY
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Dates
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Enumeration Date | 05/17/2013
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Last Update Date | 05/17/2013
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Provider Practice Location Address
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Address Line | 2200 OLYMPIC STREET
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City | SPRINGFIELD
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State | OH
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Zip | 45503
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Country | US
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Telephone | 937-568-7007
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Fax |
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Provider Business Mailing Address
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Address Line | 2200 OLYMPIC STREET
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City | SPRINGFIELD
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State | OH
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Zip | 45503
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Country | US
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Telephone | 937-568-7007
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Fax |
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Authorized Official
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Title or Position | PEDIATRIC DENTIST
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Name | DR. ANDREA MYERS
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Credential | DDS
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Telephone | 937-568-7007
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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 | 30.023909
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License Number State | OH
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