1861663551 NPI number — FAMILY DENTISTRY

Table of content: TRENTON VOSS RDN, LDN (NPI 1477376218)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1861663551 NPI number — FAMILY DENTISTRY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FAMILY DENTISTRY
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:
1861663551
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/20/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 36427
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:
45236-0427
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:
2310 BALTIMORE AVE
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:
45225
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
513-541-5599
Provider Business Practice Location Address Fax Number:
513-541-5599
Provider Enumeration Date:
03/20/2008

Additional Information

Authorized Official

Authorized Official Last Name:
HOOD
Authorized Official First Name:
WAMDA
Authorized Official Middle Name:
L
Authorized Official Title or Position:
DENTIST
Authorized Official Telephone Number:
513-541-5599

Provider Taxonomy Codes

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

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

  • Identifier: 0762447 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0002833 . This is a "AMERIGROUP-OHIO" identifier . This identifiers is of the category "OTHER".




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