Provider Demographics
NPI:1225278971
Name:SOUTHWESTERN OHIO DENTAL ASSOCIATES L.L.C.
Entity Type:Organization
Organization Name:SOUTHWESTERN OHIO DENTAL ASSOCIATES L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE PROPRIETER / OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:A
Authorized Official - Last Name:MCDONALD
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:513-825-7570
Mailing Address - Street 1:11740 HAMILTON AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45231-1255
Mailing Address - Country:US
Mailing Address - Phone:513-825-7570
Mailing Address - Fax:513-825-7999
Practice Address - Street 1:11740 HAMILTON AVE
Practice Address - Street 2:SUITE A
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45231-1255
Practice Address - Country:US
Practice Address - Phone:513-825-7570
Practice Address - Fax:513-825-7999
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-20
Last Update Date:2009-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH18367261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental