Provider Demographics
NPI:1386203396
Name:SIDNEY FAMILY DENTAL
Entity Type:Organization
Organization Name:SIDNEY FAMILY DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BEN
Authorized Official - Middle Name:
Authorized Official - Last Name:WARNOCK
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:419-230-6535
Mailing Address - Street 1:9685 HARDING HWY
Mailing Address - Street 2:
Mailing Address - City:HARROD
Mailing Address - State:OH
Mailing Address - Zip Code:45850-9424
Mailing Address - Country:US
Mailing Address - Phone:419-230-6535
Mailing Address - Fax:
Practice Address - Street 1:325 2ND AVE
Practice Address - Street 2:
Practice Address - City:SIDNEY
Practice Address - State:OH
Practice Address - Zip Code:45365-1262
Practice Address - Country:US
Practice Address - Phone:937-492-1790
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-12
Last Update Date:2019-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental