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General NPI Number Information
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NPI Number | 1841074127
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Entity Type | Organization
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Legal Business Name | VANDALIA SMILE CENTER LLC
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Dates
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Enumeration Date | 08/21/2023
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Last Update Date | 09/13/2024
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Provider Practice Location Address
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Address Line | 205 W NATIONAL RD
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City | VANDALIA
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State | OH
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Zip | 45377-1939
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Country | US
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Telephone | 937-898-8990
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Fax |
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Provider Business Mailing Address
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Address Line | 205 W NATIONAL RD
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City | VANDALIA
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State | OH
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Zip | 45377-1939
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Country | US
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Telephone | 937-898-8990
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Fax |
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Authorized Official
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Title or Position | COO
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Name | OPAL ANDERSON
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Credential |
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Telephone | 937-898-8990
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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