| Klermont 4 Kids & Adults 2 | |
|
6850 Loop Rd Centerville OH 45459-2159 | |
| (937) 439-9366 | |
| (937) 439-6687 |
| Full Name | Klermont 4 Kids & Adults 2 |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 6850 Loop Rd, Centerville, Ohio |
| Authorized Official Name and Position | William Rudolph Fry (BUSINESS MANAGER) |
| Authorized Official Contact | 5137359111 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Klermont 4 Kids & Adults 2 6850 Loop Rd Centerville OH 45459-2159 Ph: (937) 439-9366 | Klermont 4 Kids & Adults 2 6850 Loop Rd Centerville OH 45459-2159 Ph: (937) 439-9366 |
| NPI Number | 1114044625 |
|---|---|
| Provider Enumeration Date | 03/22/2007 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1114044625 | NPI | - | NPPES |
| 2554267 | Medicaid | OH | |
| $$$$$$$$$ | Other | OH | SSN |
| 0263610 | Medicaid | OH |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | 3001796 (Ohio) | Primary |
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