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4930 W Broad St Suite 3 Columbus OH 43228-1696 | |
| (614) 853-4900 | |
| (614) 853-2415 |
| Full Name | |
|---|---|
| Speciality | Clinic/center - Dental |
| Location | 4930 W Broad St, Columbus, Ohio |
| Authorized Official Name and Position | Osama Hijazi (OWNER) |
| Authorized Official Contact | 2143345797 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
4880 Wellspring Ct Dublin OH 43016-7842 Ph: () - | 4930 W Broad St Suite 3 Columbus OH 43228-1696 Ph: (614) 853-4900 |
| NPI Number | 1447654355 |
|---|---|
| Provider Enumeration Date | 10/21/2014 |
| Last Update Date | 11/18/2014 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1447654355 | NPI | - | NPPES |
| 2538203 | Medicaid | OH |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | 30-022069 (Ohio) | Primary |
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