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General NPI Number Information
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NPI Number | 1821394180
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Entity Type | Organization
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Legal Business Name | FAMILY DENTAL CARE
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Dates
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Enumeration Date | 02/03/2011
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Last Update Date | 02/03/2011
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Provider Practice Location Address
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Address Line | 1248 COLUMBUS AVE SUITE 8
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City | LEBANON
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State | OH
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Zip | 45036-8363
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Country | US
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Telephone | 513-932-0432
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Fax | 513-932-0532
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Provider Business Mailing Address
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Address Line | 1248 COLUMBUS AVE SUITE 8
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City | LEBANON
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State | OH
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Zip | 45036-8363
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Country | US
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Telephone | 513-932-0432
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Fax | 513-932-0532
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Authorized Official
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Title or Position | CEO
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Name | ALI KHAKSARFARD
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Credential | D.D.S.
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Telephone | 740-852-7741
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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 |
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License Number State |
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