=====================================================
General NPI Number Information
=====================================================
NPI Number | 1912345760
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | NATHAN JAMES POWERS D.M.D
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/13/2013
-----------------------------------------------------
Last Update Date | 07/20/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6839 WOOSTER PIKE
-----------------------------------------------------
City | MARIEMONT
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45227
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 513-271-6322
-----------------------------------------------------
Fax | 513-271-6373
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6839 WOOSTER PIKE
-----------------------------------------------------
City | CINCINNATI
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45227-4328
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 513-271-6322
-----------------------------------------------------
Fax | 513-271-6373
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | 30-024474
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------