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6460 Far Hills Avenue Centerville OH 45459 | |
(937) 433-0830 | |
(937) 433-9530 |
Full Name | |
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Speciality | Dentist - Orthodontics And Dentofacial Orthopedics |
Location | 6460 Far Hills Avenue, Centerville, Ohio |
Authorized Official Name and Position | Jack E. King (PRESIDENT) |
Authorized Official Contact | 9374330830 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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6460 Far Hills Avenue Centerville OH 45459 Ph: (937) 433-0830 | 6460 Far Hills Avenue Centerville OH 45459 Ph: (937) 433-0830 |
NPI Number | 1013051150 |
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Provider Enumeration Date | 02/19/2007 |
Last Update Date | 08/22/2020 |
Identifier | Type | State | Issuer |
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1013051150 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
1223X0400X | Dentist - Orthodontics And Dentofacial Orthopedics | 30013512 (Ohio) | Primary |
Professional Dental Alliance Of Centerville, Llc Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 9420 Dayton Lebanon Pike, Centerville, OH 45458 Phone: 937-433-8900 | |