Provider Demographics
NPI:1376000224
Name:KIDSMILES PEDIATRIC DENTAL CLINIC
Entity Type:Organization
Organization Name:KIDSMILES PEDIATRIC DENTAL CLINIC
Other - Org Name:KIDSMILES PEDIATRIC DENTAL CLINIC, JAMES A. HOMON PROF. ASSOC.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:NICOLE
Authorized Official - Last Name:ZUBER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:614-458-1711
Mailing Address - Street 1:770 BETHEL RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43214-1900
Mailing Address - Country:US
Mailing Address - Phone:614-458-1711
Mailing Address - Fax:614-458-1713
Practice Address - Street 1:770 BETHEL RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43214-1900
Practice Address - Country:US
Practice Address - Phone:614-458-1711
Practice Address - Fax:614-458-1713
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-27
Last Update Date:2019-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental