MEDICARE: PEDIATRIC DENTAL ASSOCIATES OF WEST CHESTER

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	1223P0221X	Pediatric Dentistry	30014442	OH

General Provider Information

NPI Number	:	1518912831
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PEDIATRIC DENTAL ASSOCIATES OF WEST CHESTER

Provider Business Mailing Address
First Line	:	9215 CINCINNATI COLUMBUS RD
Second Line	:
City	:	WEST CHESTER
State	:	OH
Zip	:	45069-4143
Country	:	US
Telephone Number	:	513-777-2313
Fax Number	:	513-779-5942

Provider Business Practice Location Address
First Line	:	9215 CINCINNATI COLUMBUS RD
Second Line	:
City	:	WEST CHESTER
State	:	OH
Zip	:	45069-4143
Country	:	US
Telephone Number	:	513-777-2313
Fax Number	:	513-779-5942

Authorized Official
Title or Position	:	OFFICER
Name	:	ERIC JOHN KOREN
Credential	:	DDS
Telephone Number	:	513-777-2313

Provider Enumeration Date	:	05/24/2006
Last Update Date	:	08/20/2008

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