Provider Demographics
NPI:1013441872
Name:DENTAL SPECIALISTS OF CENTRAL OHIO
Entity type:Organization
Organization Name:DENTAL SPECIALISTS OF CENTRAL OHIO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:C
Authorized Official - Last Name:ANTHONY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:740-913-0328
Mailing Address - Street 1:PO BOX 798
Mailing Address - Street 2:
Mailing Address - City:SUNBURY
Mailing Address - State:OH
Mailing Address - Zip Code:43074-0798
Mailing Address - Country:US
Mailing Address - Phone:740-913-0328
Mailing Address - Fax:
Practice Address - Street 1:257 W GRANVILLE ST
Practice Address - Street 2:SUITE 202
Practice Address - City:SUNBURY
Practice Address - State:OH
Practice Address - Zip Code:43074-9684
Practice Address - Country:US
Practice Address - Phone:740-913-0328
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-18
Last Update Date:2017-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty
No1223E0200XDental ProvidersDentistEndodonticsGroup - Multi-Specialty
No1223P0221XDental ProvidersDentistPediatric DentistryGroup - Multi-Specialty
No1223P0300XDental ProvidersDentistPeriodonticsGroup - Multi-Specialty
No1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Multi-Specialty
No1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Multi-Specialty