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8086 E Broad St Reynoldsburg OH 43068 | |
| (614) 328-9661 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 8086 E Broad St, Reynoldsburg, Ohio |
| Authorized Official Name and Position | Kendra Walker (CREDENTIALING COORDINATOR) |
| Authorized Official Contact | 2175408312 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
8086 E Broad St Reynoldsburg OH 43068-8024 Ph: (614) 328-9661 | 8086 E Broad St Reynoldsburg OH 43068 Ph: (614) 328-9661 |
| NPI Number | 1992197883 |
|---|---|
| Provider Enumeration Date | 03/02/2015 |
| Last Update Date | 03/04/2015 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1992197883 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | 30024311 (Ohio) | Primary |
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