1598842734 NPI number — DONNA J MILLER DMD DANIEL F GREEN DDS & JEREMY D CRABTREE DDS INC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1598842734 NPI number — DONNA J MILLER DMD DANIEL F GREEN DDS & JEREMY D CRABTREE DDS INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DONNA J MILLER DMD DANIEL F GREEN DDS & JEREMY D CRABTREE 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:
FAMILY DENTAL CENTER
Provider Other Organization Name Type Code:
3
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:
1598842734
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/28/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
102 N SCIOTO ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CIRCLEVILLE
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
43113-1630
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
740-477-3174
Provider Business Mailing Address Fax Number:
740-477-2616

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
102 N SCIOTO ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CIRCLEVILLE
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43113-1630
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
740-477-3174
Provider Business Practice Location Address Fax Number:
740-477-2616
Provider Enumeration Date:
11/01/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
SKLENAR
Authorized Official First Name:
SUE
Authorized Official Middle Name:
Authorized Official Title or Position:
BUSINESS MANAGER
Authorized Official Telephone Number:
740-773-4066

Provider Taxonomy Codes

  • Taxonomy code: 261QD0000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0916601 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".