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General NPI Number Information
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NPI Number | 1932832409
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Entity Type | Organization
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Legal Business Name | NORTH ORANGE SMILE CENTER
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Dates
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Enumeration Date | 07/02/2022
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Last Update Date | 07/02/2022
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Provider Practice Location Address
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Address Line | 7420 GOODING BLVD STE 200
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City | DELAWARE
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State | OH
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Zip | 43015-7086
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Country | US
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Telephone | 614-507-7339
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Fax |
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Provider Business Mailing Address
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Address Line | 10576 ASH GROVE CT
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City | PLAIN CITY
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State | OH
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Zip | 43064-3519
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Country | US
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Telephone | 614-507-7339
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Fax |
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Authorized Official
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Title or Position | DENTIST/PARTNER
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Name | DR. JACK MINNILLO
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Credential | DDS
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Telephone | 614-507-7339
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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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