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6100 E Main St Suite 100 Columbus OH 43213-3399 | |
| (614) 694-0363 | |
| (614) 694-0371 |
| Full Name | |
|---|---|
| Speciality | Dentist |
| Location | 6100 E Main St, Columbus, Ohio |
| Authorized Official Name and Position | Lisa A Carrington (OFFICE MANGER) |
| Authorized Official Contact | 6146940363 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
6100 E Main St Suite 100 Columbus OH 43213-3399 Ph: (614) 694-0363 | 6100 E Main St Suite 100 Columbus OH 43213-3399 Ph: (614) 694-0363 |
| NPI Number | 1710348057 |
|---|---|
| Provider Enumeration Date | 03/15/2016 |
| Last Update Date | 03/15/2016 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1710348057 | NPI | - | NPPES |
| 38529 | Medicaid | OH |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | 30023886 (Ohio) | Primary |
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