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NPI Code Detail

MEDICARE: OHIO DENTAL PROFESSIONALS, DELISLE, P.C.

MEDICARE: OHIO DENTAL PROFESSIONALS, DELISLE, P.C.
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
1122300000XDentist

General Provider Information

NPI Number : 1225787666
Entity Type Code : Organization
Provider Name (Legal Business Name) : OHIO DENTAL PROFESSIONALS, DELISLE, P.C.
Provider Business Mailing Address
First Line : 8321 N MAIN ST
Second Line :
City : DAYTON
State : OH
Zip : 45415-1602
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 8321 N MAIN ST
Second Line :
City : DAYTON
State : OH
Zip : 45415-1602
Country : US
Telephone Number : 937-890-8957
Fax Number :
Authorized Official
Title or Position : CREDENTIALING COORDINATOR
Name : HILLARY THULL
Credential :
Telephone Number : 217-540-8946
Provider Enumeration Date : 03/22/2022
Last Update Date : 03/22/2022

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Directions to “OHIO DENTAL PROFESSIONALS, DELISLE, P.C. ” Practice Location

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