Provider Demographics
NPI:1538389853
Name:OHIO DENTAL PROFESSIONALS WORKMAN, PC
Entity type:Organization
Organization Name:OHIO DENTAL PROFESSIONALS WORKMAN, PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:KENDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:WALKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:217-540-5100
Mailing Address - Street 1:780 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGBORO
Mailing Address - State:OH
Mailing Address - Zip Code:45066-8944
Mailing Address - Country:US
Mailing Address - Phone:937-748-9125
Mailing Address - Fax:937-748-9126
Practice Address - Street 1:780 NORTH MAIN ST
Practice Address - Street 2:
Practice Address - City:SPRINGBORO
Practice Address - State:OH
Practice Address - Zip Code:45066
Practice Address - Country:US
Practice Address - Phone:937-748-9125
Practice Address - Fax:937-748-9126
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:OHIO DENTAL PROFESSIONALS WORKMAN, PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-04-27
Last Update Date:2014-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty