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6040 Wilmington Pike Centerville OH 45459-7006 | |
| (937) 778-0150 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 6040 Wilmington Pike, Centerville, Ohio |
| Authorized Official Name and Position | Rhonda Keller (DISTRICT MANAGER) |
| Authorized Official Contact | 9372787956 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
6040 Wilmington Pike Centerville OH 45459-7006 Ph: (937) 778-0150 | 6040 Wilmington Pike Centerville OH 45459-7006 Ph: (937) 778-0150 |
| NPI Number | 1033393558 |
|---|---|
| Provider Enumeration Date | 12/19/2007 |
| Last Update Date | 12/19/2007 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1033393558 | NPI | - | NPPES |
| 2183613 | Medicaid | OH |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | 30.019758 (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 | |