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General NPI Number Information
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NPI Number | 1972815124
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Entity Type | Individual
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Provider Name | JOHN G. IMM III D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 07/04/2010
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Last Update Date | 04/05/2017
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Provider Practice Location Address
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Address Line | 3380 TREMONT RD SUITE 190
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City | COLUMBUS
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State | OH
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Zip | 43221-2112
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Country | US
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Telephone | 614-451-5435
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Fax | 614-326-2526
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Provider Business Mailing Address
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Address Line | 3380 TREMONT RD SUITE 190
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City | COLUMBUS
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State | OH
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Zip | 43221-2112
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Country | US
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Telephone | 614-451-5435
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Fax | 614-326-2526
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 843
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License Number State | FL
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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 | 30-023277
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License Number State | OH
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