Provider Demographics
NPI:1649057894
Name:BLANK DENTAL MANAGEMENT CO, LLC
Entity type:Organization
Organization Name:BLANK DENTAL MANAGEMENT CO, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:TYLER
Authorized Official - Middle Name:
Authorized Official - Last Name:SHINKLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:513-368-2497
Mailing Address - Street 1:9733 SAWMILL PKWY UNIT C
Mailing Address - Street 2:
Mailing Address - City:POWELL
Mailing Address - State:OH
Mailing Address - Zip Code:43065-6101
Mailing Address - Country:US
Mailing Address - Phone:614-764-1013
Mailing Address - Fax:
Practice Address - Street 1:9733 SAWMILL PKWY UNIT C
Practice Address - Street 2:
Practice Address - City:POWELL
Practice Address - State:OH
Practice Address - Zip Code:43065-6101
Practice Address - Country:US
Practice Address - Phone:614-764-1013
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BLANK DENTAL MANAGEMENT CO, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-09-12
Last Update Date:2023-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty