MEDICARE: TRUSTED SMILES DENTAL CARE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	30020433	OH

General Provider Information

NPI Number	:	1174073670
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TRUSTED SMILES DENTAL CARE

Provider Business Mailing Address
First Line	:	959 HARRISON AVE
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43201-3324
Country	:	US
Telephone Number	:	614-428-0487
Fax Number	:	614-568-1808

Provider Business Practice Location Address
First Line	:	959 HARRISON AVE
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43201-3324
Country	:	US
Telephone Number	:	614-428-0487
Fax Number	:	614-568-1808

Authorized Official
Title or Position	:	MANAGING PARTNER/OWNER
Name	:	DR. JEFF KOVER
Credential	:	D.D.S.
Telephone Number	:	614-428-0487

Provider Enumeration Date	:	10/07/2016
Last Update Date	:	10/07/2016

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