Provider Demographics
NPI:1861688020
Name:EZIS & BLUME DDS, MS LLC
Entity type:Organization
Organization Name:EZIS & BLUME DDS, MS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:BEVERLY
Authorized Official - Middle Name:
Authorized Official - Last Name:DENNIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:513-871-8488
Mailing Address - Street 1:4030 SMITH RD
Mailing Address - Street 2:SUITE 225
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45209-2207
Mailing Address - Country:US
Mailing Address - Phone:513-871-8488
Mailing Address - Fax:513-871-8490
Practice Address - Street 1:4030 SMITH RD
Practice Address - Street 2:SUITE 225
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45209-1957
Practice Address - Country:US
Practice Address - Phone:513-871-8488
Practice Address - Fax:513-871-8490
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-21
Last Update Date:2007-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30-01-42841223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Single Specialty