Provider Demographics
NPI:1376752378
Name:DUCKWORTH, JOHN EDMOND (DMD, MMEDSC)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:EDMOND
Last Name:DUCKWORTH
Suffix:
Gender:M
Credentials:DMD, MMEDSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5050 BLAZER PKWY
Mailing Address - Street 2:SUITE 201
Mailing Address - City:DUBLIN
Mailing Address - State:OH
Mailing Address - Zip Code:43017-3361
Mailing Address - Country:US
Mailing Address - Phone:614-761-1408
Mailing Address - Fax:614-761-1408
Practice Address - Street 1:5050 BLAZER PKWY
Practice Address - Street 2:SUITE 201
Practice Address - City:DUBLIN
Practice Address - State:OH
Practice Address - Zip Code:43017-3361
Practice Address - Country:US
Practice Address - Phone:614-761-1408
Practice Address - Fax:614-761-1408
Is Sole Proprietor?:No
Enumeration Date:2007-05-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH171881223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics