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General NPI Number Information
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NPI Number | 1982529780
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Entity Type | Organization
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Legal Business Name | TRAILSIDE DENTAL PARTNERS LLC
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Dates
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Enumeration Date | 08/11/2026
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Last Update Date | 08/11/2026
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Provider Practice Location Address
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Address Line | 5382 COX SMITH RD STE D
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City | MASON
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State | OH
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Zip | 45040-6803
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Country | US
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Telephone | 513-229-7711
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Fax |
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Provider Business Mailing Address
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Address Line | 6598 WYNDWATCH DR
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City | CINCINNATI
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State | OH
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Zip | 45230-5266
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Country | US
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Telephone | 720-822-3502
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Fax |
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Authorized Official
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Title or Position | VICE PRESIDENT
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Name | MR. CHAD MALENFANT
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Credential |
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Telephone | 720-822-3502
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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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