Provider Demographics
NPI:1083165385
Name:FOREST PARK DENTAL, LLC- JOHN P HARMEYER, DDS
Entity Type:Organization
Organization Name:FOREST PARK DENTAL, LLC- JOHN P HARMEYER, DDS
Other - Org Name:FOREST PARK DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:PATRICK
Authorized Official - Last Name:HARMEYER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:513-648-9900
Mailing Address - Street 1:1295 KEMPER MEADOW DR
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45240-1633
Mailing Address - Country:US
Mailing Address - Phone:513-648-9900
Mailing Address - Fax:
Practice Address - Street 1:1295 KEMPER MEADOW DR
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45240-1633
Practice Address - Country:US
Practice Address - Phone:513-648-9900
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-21
Last Update Date:2016-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH199041223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH238577Medicaid