Provider Demographics
NPI:1073836789
Name:CITY OF CINCINNATI
Entity Type:Organization
Organization Name:CITY OF CINCINNATI
Other - Org Name:CINCINNATI HEALTH DEPT CREST SMILE SHOPPE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:HEALTH COMMISSIONER
Authorized Official - Prefix:DR
Authorized Official - First Name:NOBLE
Authorized Official - Middle Name:
Authorized Official - Last Name:MASERU
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, MS
Authorized Official - Phone:513-357-7280
Mailing Address - Street 1:3101 BURNET AVE
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45229-3014
Mailing Address - Country:US
Mailing Address - Phone:513-357-7280
Mailing Address - Fax:513-357-7477
Practice Address - Street 1:612 ROCKDALE AVE
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45229-2919
Practice Address - Country:US
Practice Address - Phone:513-352-4072
Practice Address - Fax:513-357-7477
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CITY OF CINCINNATI- CINCINNATI HEALTH DEPT
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-03-09
Last Update Date:2010-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care