Provider Demographics
NPI:1093817835
Name:ATHENS DENTAL ARTS
Entity Type:Organization
Organization Name:ATHENS DENTAL ARTS
Other - Org Name:ATHENS DENTAL ARTS
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:C
Authorized Official - Last Name:WELSH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:740-593-8530
Mailing Address - Street 1:207 N COLUMBUS ROAD
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:OH
Mailing Address - Zip Code:45701-1335
Mailing Address - Country:US
Mailing Address - Phone:740-593-8530
Mailing Address - Fax:740-594-2215
Practice Address - Street 1:207 N COLUMBUS ROAD
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:OH
Practice Address - Zip Code:45701
Practice Address - Country:US
Practice Address - Phone:740-593-8530
Practice Address - Fax:740-594-2215
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-02
Last Update Date:2018-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH14320122300000X
OH20749122300000X
OH17938122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0219641Medicaid
OH2232113Medicaid
OH2220653OtherDR ELIZABETH WELSH
OH0749OtherPIN WELFARE