MEDICARE: RUNION DENTAL GROUP,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	30-023280	OH

General Provider Information

NPI Number	:	1932461837
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RUNION DENTAL GROUP,LLC

Provider Business Mailing Address
First Line	:	1110 BEECHER XING N
Second Line	:	SUITE A
City	:	GAHANNA
State	:	OH
Zip	:	43230-4564
Country	:	US
Telephone Number	:	614-775-1300
Fax Number	:	614-775-9355

Provider Business Practice Location Address
First Line	:	1110 BEECHER XING N
Second Line	:	SUITE A
City	:	GAHANNA
State	:	OH
Zip	:	43230-4564
Country	:	US
Telephone Number	:	614-775-1300
Fax Number	:	614-775-9355

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	MRS. SAMANTHA J NORMAN
Credential	:
Telephone Number	:	614-775-1300

Provider Enumeration Date	:	06/15/2012
Last Update Date	:	06/15/2012

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