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General NPI Number Information
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NPI Number | 1962204453
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Entity Type | Organization
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Legal Business Name | GADDIS FAMILY DENTAL LLC
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Dates
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Enumeration Date | 03/25/2025
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Last Update Date | 03/25/2025
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Provider Practice Location Address
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Address Line | 104 S MAIN ST
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City | BALTIMORE
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State | OH
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Zip | 43105-1426
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Country | US
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Telephone | 740-500-4746
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Fax |
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Provider Business Mailing Address
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Address Line | 421 NEW ENGLAND HILL RD
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City | SHAWNEE
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State | OH
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Zip | 43782-9736
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Country | US
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Telephone | 740-684-0302
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. JOSHUA W GADDIS
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Credential | DDS
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Telephone | 740-684-0302
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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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