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6450 Centerville Business Pkwy Centerville OH 45459-2633 | |
(217) 540-5100 | |
Not Available |
Full Name | |
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Speciality | Dentist |
Location | 6450 Centerville Business Pkwy, Centerville, Ohio |
Authorized Official Name and Position | Marie Kuhl (CREDENTIALING MANAGER) |
Authorized Official Contact | 2175405100 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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6450 Centerville Business Pkwy Centerville OH 45459-2633 Ph: (217) 540-5100 | 6450 Centerville Business Pkwy Centerville OH 45459-2633 Ph: (217) 540-5100 |
NPI Number | 1336485580 |
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Provider Enumeration Date | 12/17/2012 |
Last Update Date | 12/17/2012 |
Identifier | Type | State | Issuer |
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1336485580 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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122300000X | Dentist | (* (Not Available)) | 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 | |