1356811731 NPI number — JOHN C. BOAIN, DDS DENTAL CARE, LLC

Table of content: MELANIE AQUINO DUNNIWAY OTR (NPI 1114123825)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1356811731 NPI number — JOHN C. BOAIN, DDS DENTAL CARE, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JOHN C. BOAIN, DDS DENTAL CARE, 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:
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:
1356811731
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/12/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9825 KENWOOD RD STE 200
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BLUE ASH
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
45242-6252
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
513-808-4984
Provider Business Mailing Address Fax Number:
513-448-0511

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1001 DUNN RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FLORISSANT
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
63031-8215
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
314-921-3527
Provider Business Practice Location Address Fax Number:
314-921-7855
Provider Enumeration Date:
11/28/2018

Additional Information

Authorized Official

Authorized Official Last Name:
JUSTICE
Authorized Official First Name:
TY
Authorized Official Middle Name:
V.
Authorized Official Title or Position:
DIRECTOR, PAYER RELATIONS
Authorized Official Telephone Number:
513-808-4984

Provider Taxonomy Codes

  • Taxonomy code: 122300000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1223G0001X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2026 www.npivalidator.com