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General NPI Number Information
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NPI Number | 1881991313
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Entity Type | Organization
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Legal Business Name | GAHANNA DENTAL PARTNERS, LLP
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Dates
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Enumeration Date | 02/18/2011
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Last Update Date | 06/01/2011
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Provider Practice Location Address
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Address Line | 4693 MORSE RD.
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City | GAHANNA
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State | OH
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Zip | 43230
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Country | US
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Telephone | 614-471-7800
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Fax | 614-471-7802
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Provider Business Mailing Address
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Address Line | 4693 MORSE RD.
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City | GAHANNA
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State | OH
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Zip | 43230
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Country | US
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Telephone | 614-471-7800
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Fax | 614-471-7802
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Authorized Official
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Title or Position | DENTIST
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Name | DR. DAVID WISE
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Credential | DDS
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Telephone | 614-471-7800
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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 | 022857
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 022814
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License Number State | OH
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