Provider Demographics
NPI:1003207010
Name:SWEET TOOTH COMPREHENSIVE DENTISTRY
Entity Type:Organization
Organization Name:SWEET TOOTH COMPREHENSIVE DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAWN
Authorized Official - Middle Name:LOUISE
Authorized Official - Last Name:BROYLES
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:513-541-5599
Mailing Address - Street 1:PO BOX 36427
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45236-0427
Mailing Address - Country:US
Mailing Address - Phone:513-541-5599
Mailing Address - Fax:
Practice Address - Street 1:2310 BALTIMORE AVE
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45225-1104
Practice Address - Country:US
Practice Address - Phone:513-541-5599
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-12
Last Update Date:2015-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30.0232311223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty