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General NPI Number Information
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NPI Number | 1871608380
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Entity Type | Organization
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Legal Business Name | DENTAL CLINIC COLLEGE OF DENTISTRY
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Dates
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Enumeration Date | 08/21/2006
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Last Update Date | 09/17/2013
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Provider Practice Location Address
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Address Line | 305 W 12TH AVE ROOM 1130 POSTLE HALL
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City | COLUMBUS
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State | OH
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Zip | 43210-1267
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Country | US
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Telephone | 614-292-6983
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Fax | 614-688-3671
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Provider Business Mailing Address
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Address Line | 305 W 12TH AVE ROOM 1130 POSTLE HALL
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City | COLUMBUS
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State | OH
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Zip | 43210-1267
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Country | US
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Telephone | 614-292-6983
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Fax | 614-688-3671
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Authorized Official
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Title or Position | ASSISTANT DEAN
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Name | DR. HENRY FISCHBACH
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Credential | DDS
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Telephone | 614-292-0050
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number |
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License Number State |
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