Provider Demographics
NPI:1265039465
Name:FRESH DENTAL
Entity Type:Organization
Organization Name:FRESH DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:EJAZ
Authorized Official - Middle Name:AHMED
Authorized Official - Last Name:LAKHANI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:513-697-1211
Mailing Address - Street 1:11907 MONTGOMERY RD
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45249-1794
Mailing Address - Country:US
Mailing Address - Phone:513-697-1211
Mailing Address - Fax:
Practice Address - Street 1:11907 MONTGOMERY RD
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45249-1794
Practice Address - Country:US
Practice Address - Phone:513-697-1211
Practice Address - Fax:513-697-1214
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-01
Last Update Date:2020-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental