1134515323 NPI number — JOSEPH DENTAL OF WHEELERSBURG LLC

Table of content: GABRIELLE CHRISTINA SCHULZ BA, RBT (NPI 1649051145)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1134515323 NPI number — JOSEPH DENTAL OF WHEELERSBURG LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JOSEPH DENTAL OF WHEELERSBURG LLC
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:
1134515323
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/14/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8714 TENNYSON AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WHEELERSBURG
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
45694-1932
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8714 TENNYSON AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WHEELERSBURG
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45694-1932
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
740-574-8044
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/14/2015

Additional Information

Authorized Official

Authorized Official Last Name:
JOSEPH
Authorized Official First Name:
JOE
Authorized Official Middle Name:
ROBERT
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
614-777-9884

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , with the licence number:  19829 , 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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