MEDICARE: DENTAL IMPLANT CENTER OF OHIO

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	18579	OH

General Provider Information

NPI Number	:	1306030317
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DENTAL IMPLANT CENTER OF OHIO

Provider Business Mailing Address
First Line	:	4050 COTTINGHAM DR
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45241-1626
Country	:	US
Telephone Number	:	513-563-0201
Fax Number	:	513-407-5247

Provider Business Practice Location Address
First Line	:	4050 COTTINGHAM DR
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45241-1626
Country	:	US
Telephone Number	:	513-563-0201
Fax Number	:	513-407-5247

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. EUNJIN HAN SUH
Credential	:	D.D.S.
Telephone Number	:	513-563-0201

Provider Enumeration Date	:	09/02/2007
Last Update Date	:	09/02/2007

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