1114140746 NPI number — TIMOTHY W. PETERS DDS & ERICH D. LENZ DDS INC

Table of content: (NPI 1114140746)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1114140746 NPI number — TIMOTHY W. PETERS DDS & ERICH D. LENZ DDS INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TIMOTHY W. PETERS DDS & ERICH D. LENZ DDS 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:
Provider Other Organization Name Type Code:
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:
1114140746
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/17/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7465 DEER RUN LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CINCINNATI
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
45233-4212
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
513-941-4666
Provider Business Mailing Address Fax Number:
513-598-1700

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6431 BRIDGETOWN RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CINCINNATI
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45248-2934
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
513-574-1477
Provider Business Practice Location Address Fax Number:
513-598-1700
Provider Enumeration Date:
04/11/2007

Additional Information

Authorized Official

Authorized Official Last Name:
PETERS
Authorized Official First Name:
DEE
Authorized Official Middle Name:
G.
Authorized Official Title or Position:
OFFICE MANAGER
Authorized Official Telephone Number:
513-941-4666

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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