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General NPI Number Information
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NPI Number | 1992508097
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Entity Type | Organization
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Legal Business Name | ANTHONY DENTAL CARE - SOUTH HIGH LLC
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Dates
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Enumeration Date | 04/01/2025
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Last Update Date | 04/01/2025
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Provider Practice Location Address
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Address Line | 3476 S HIGH ST
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City | COLUMBUS
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State | OH
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Zip | 43207-4007
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Country | US
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Telephone | 740-965-4090
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Fax | 740-965-9921
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Provider Business Mailing Address
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Address Line | 257 W GRANVILLE ST STE 200
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City | SUNBURY
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State | OH
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Zip | 43074-9684
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Country | US
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Telephone | 740-965-4090
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Fax | 740-965-9921
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Authorized Official
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Title or Position | OM
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Name | TRACEY RECKNER
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Credential |
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Telephone | 740-965-4090
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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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