Provider Demographics
NPI:1275383127
Name:STELLAR DENTISTRY OF GAHANNA, LLC
Entity Type:Organization
Organization Name:STELLAR DENTISTRY OF GAHANNA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ZIAD
Authorized Official - Middle Name:
Authorized Official - Last Name:AL HENNAWI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:614-974-2900
Mailing Address - Street 1:PO BOX 1412
Mailing Address - Street 2:
Mailing Address - City:HILLIARD
Mailing Address - State:OH
Mailing Address - Zip Code:43026-6412
Mailing Address - Country:US
Mailing Address - Phone:614-974-2900
Mailing Address - Fax:
Practice Address - Street 1:1163 N HAMILTON RD
Practice Address - Street 2:
Practice Address - City:GAHANNA
Practice Address - State:OH
Practice Address - Zip Code:43230-3452
Practice Address - Country:US
Practice Address - Phone:614-974-2900
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-25
Last Update Date:2024-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty