MEDICARE: REM DDS 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	261QD0000X	Dental Clinic/Center

General Provider Information

NPI Number	:	1740068733
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	REM DDS LLC

Provider Business Mailing Address
First Line	:	4034 MORSE RD
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43219-3018
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4034 MORSE RD
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43219-3018
Country	:	US
Telephone Number	:	402-505-6843
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	RIKKI LIEBERTH
Credential	:
Telephone Number	:	402-505-6843

Provider Enumeration Date	:	09/20/2023
Last Update Date	:	09/20/2023

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Directions to “REM DDS LLC ” Practice Location

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