Provider Demographics
NPI:1164553640
Name:COMMUNITY DENTAL CARE INC.
Entity Type:Organization
Organization Name:COMMUNITY DENTAL CARE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GREGG
Authorized Official - Middle Name:L
Authorized Official - Last Name:TESTERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:513-932-4806
Mailing Address - Street 1:767 COLUMBUS AVE
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:OH
Mailing Address - Zip Code:45036-1749
Mailing Address - Country:US
Mailing Address - Phone:513-932-4806
Mailing Address - Fax:513-932-4274
Practice Address - Street 1:767 COLUMBUS AVE
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:OH
Practice Address - Zip Code:45036-1749
Practice Address - Country:US
Practice Address - Phone:513-932-4806
Practice Address - Fax:513-932-4274
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30.0152201223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty