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NPI Code Detail

MEDICARE: EDWARD DESATNIK D.D.S.

MEDICARE: EDWARD DESATNIK D.D.S.
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
11223X0400XOrthodontics and Dentofacial Orthopedics Dentistry30.010761OH

General Provider Information

NPI Number : 1356387542
Entity Type Code : Organization
Provider Name (Legal Business Name) : EDWARD DESATNIK D.D.S.
Provider Business Mailing Address
First Line : 12105 SHERATON LN
Second Line :
City : CINCINNATI
State : OH
Zip : 45246-1613
Country : US
Telephone Number : 513-671-6722
Fax Number : 513-985-9014
Provider Business Practice Location Address
First Line : 12105 SHERATON LN
Second Line :
City : CINCINNATI
State : OH
Zip : 45246-1613
Country : US
Telephone Number : 513-671-6722
Fax Number : 513-985-9014
Authorized Official
Title or Position : PRESIDENT
Name : DR. EDWARD DESATNIK
Credential : D.D.S.
Telephone Number : 513-671-6722
Provider Enumeration Date : 06/22/2006
Last Update Date : 08/22/2020

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