MEDICARE: DR. DAVID P, SOUTHWOOD D.M.D.

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	17691	OH

General Provider Information

NPI Number	:	1548596752
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DAVID P, SOUTHWOOD D.M.D.

Provider Business Mailing Address
First Line	:	3557 SPRINGDALE RD
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45251-1314
Country	:	US
Telephone Number	:	513-385-5400
Fax Number	:	513-385-5400

Provider Business Practice Location Address
First Line	:	3557 SPRINGDALE RD
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45251-1314
Country	:	US
Telephone Number	:	513-385-5400
Fax Number	:	513-385-5400

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/22/2009
Last Update Date	:	10/22/2009

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Directions to “ DR. DAVID P, SOUTHWOOD D.M.D.” Practice Location

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