MEDICARE: OHIO COSMETIC DENTISTS, LLC

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	1223G0001X	General Practice Dentistry

General Provider Information

NPI Number	:	1386527984
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OHIO COSMETIC DENTISTS, LLC

Provider Business Mailing Address
First Line	:	1010 BETHEL RD
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43214-1908
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1010 BETHEL RD
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43214-1908
Country	:	US
Telephone Number	:	614-459-7300
Fax Number	:

Authorized Official
Title or Position	:	SR CREDENTIALING TEAM LEAD
Name	:	JENNY GARCIA-ROCHA
Credential	:
Telephone Number	:	972-869-3789

Provider Enumeration Date	:	07/30/2025
Last Update Date	:	07/30/2025

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