Provider Demographics
NPI:1700121159
Name:KATHLEEN A VARLEY DDS LLC
Entity type:Organization
Organization Name:KATHLEEN A VARLEY DDS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:A
Authorized Official - Last Name:VARLEY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:614-864-4200
Mailing Address - Street 1:1600 BRICE RD
Mailing Address - Street 2:
Mailing Address - City:REYNOLDSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:43068-2795
Mailing Address - Country:US
Mailing Address - Phone:614-864-4200
Mailing Address - Fax:
Practice Address - Street 1:1600 BRICE RD
Practice Address - Street 2:
Practice Address - City:REYNOLDSBURG
Practice Address - State:OH
Practice Address - Zip Code:43068-2795
Practice Address - Country:US
Practice Address - Phone:614-864-4200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-11
Last Update Date:2012-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30.0228091223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH1386805695OtherNPI INDIVIDUAL
OH30.022809OtherSTATE LICENSE