| Knickerbocker Pediatric Dentistry Llc | |
|
1 Childrens Plz Dayton OH 45404-1873 | |
| (937) 619-9828 | |
| Not Available |
| Full Name | Knickerbocker Pediatric Dentistry Llc |
|---|---|
| Speciality | Dentist - Pediatric Dentistry |
| Location | 1 Childrens Plz, Dayton, Ohio |
| Authorized Official Name and Position | Betty Huang (PRESIDENT) |
| Authorized Official Contact | 4194630023 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Knickerbocker Pediatric Dentistry Llc Po Box 752144 Dayton OH 45475-2144 Ph: () - | Knickerbocker Pediatric Dentistry Llc 1 Childrens Plz Dayton OH 45404-1873 Ph: (937) 619-9828 |
| NPI Number | 1447617006 |
|---|---|
| Provider Enumeration Date | 01/26/2016 |
| Last Update Date | 01/26/2016 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1447617006 | NPI | - | NPPES |
| 0054438 | Medicaid | OH |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223P0221X | Dentist - Pediatric Dentistry | 30-023424 (Ohio) | Primary |
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