1639229735 NPI number — PARK DENTAL CARE OF HAMILTON OH INC

Table of content: (NPI 1639229735)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1639229735 NPI number — PARK DENTAL CARE OF HAMILTON OH INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PARK DENTAL CARE OF HAMILTON OH INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
PAUL W GRIESELHUBER AND RENE W GRIESELHUBER DDS INC
Provider Other Organization Name Type Code:
4
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1639229735
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/17/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
345 PARK AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HAMILTON
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
45013-3078
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
513-896-7979
Provider Business Mailing Address Fax Number:
513-896-1081

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
345 PARK AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HAMILTON
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45013-3078
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
513-896-7979
Provider Business Practice Location Address Fax Number:
513-896-1081
Provider Enumeration Date:
01/11/2007

Additional Information

Authorized Official

Authorized Official Last Name:
LEIBFORTH
Authorized Official First Name:
JEFFERY
Authorized Official Middle Name:
KARL
Authorized Official Title or Position:
PRESIDENT/OWNER
Authorized Official Telephone Number:
513-896-7979

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , with the licence number:  15471 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 1223G0001X , with the licence number: 14379 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1223G0001X , with the licence number: 11813 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1223G0001X , with the licence number: 21176 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)





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