Provider Demographics
NPI:1194043299
Name:CLERMONT COUNTY COMMUNITY SERVICE
Entity Type:Organization
Organization Name:CLERMONT COUNTY COMMUNITY SERVICE
Other - Org Name:CLERMONT DENTAL
Other - Org Type:Other Name
Authorized Official - Title/Position:OFFICE MANGER
Authorized Official - Prefix:MISS
Authorized Official - First Name:DAWN
Authorized Official - Middle Name:
Authorized Official - Last Name:BAIRD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:513-735-8804
Mailing Address - Street 1:3003 HOSPITAL DR
Mailing Address - Street 2:
Mailing Address - City:BATAVIA
Mailing Address - State:OH
Mailing Address - Zip Code:45103-2689
Mailing Address - Country:US
Mailing Address - Phone:513-735-8804
Mailing Address - Fax:513-735-8839
Practice Address - Street 1:3003 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:BATAVIA
Practice Address - State:OH
Practice Address - Zip Code:45103-2689
Practice Address - Country:US
Practice Address - Phone:513-735-8804
Practice Address - Fax:513-735-8839
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-13
Last Update Date:2010-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0232153Medicaid