| Immediadent | |
|
6323 Tussing Rd Reynoldsburg OH 43068-3984 | |
| (614) 863-2222 | |
| (913) 800-6967 |
| Full Name | Immediadent |
|---|---|
| Speciality | Dentist |
| Location | 6323 Tussing Rd, Reynoldsburg, Ohio |
| Authorized Official Name and Position | Amy Wheeler (CREDENTIALING COORDINATOR) |
| Authorized Official Contact | 9138006952 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Immediadent Po Box 11568 Overland Park KS 66207-4268 Ph: (913) 428-1674 | Immediadent 6323 Tussing Rd Reynoldsburg OH 43068-3984 Ph: (614) 863-2222 |
| NPI Number | 1073648622 |
|---|---|
| Provider Enumeration Date | 02/23/2007 |
| Last Update Date | 04/12/2017 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1073648622 | NPI | - | NPPES |
| 2569206 | Medicaid | OH |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | (* (Not Available)) | Primary |
| 122300000X | Dentist | 22001 (Ohio) | Secondary |
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