1205019817 NPI number — DENTAL SERVICES OF OHIO

Table of content: (NPI 1205019817)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1205019817 NPI number — DENTAL SERVICES OF OHIO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DENTAL SERVICES OF OHIO
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:
6
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:
1205019817
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/12/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 11568
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OVERLAND PARK
Provider Business Mailing Address State Name:
KS
Provider Business Mailing Address Postal Code:
66207-4268
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
913-428-1674
Provider Business Mailing Address Fax Number:
913-800-6967

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7420 MILLER LN
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DAYTON
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45414-2442
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
937-890-8901
Provider Business Practice Location Address Fax Number:
913-800-6967
Provider Enumeration Date:
12/06/2007

Additional Information

Authorized Official

Authorized Official Last Name:
WHEELER
Authorized Official First Name:
AMY
Authorized Official Middle Name:
Authorized Official Title or Position:
CREDENTIALING COORDINATOR
Authorized Official Telephone Number:
913-800-6952

Provider Taxonomy Codes

  • Taxonomy code: 122300000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QD0000X , with the licence number: 30-021038 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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