Provider Demographics
NPI:1417167552
Name:MARJOLEIN V ANCONA, DMD, INC
Entity Type:Organization
Organization Name:MARJOLEIN V ANCONA, DMD, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DR
Authorized Official - Prefix:DR
Authorized Official - First Name:MARJOLEIN
Authorized Official - Middle Name:V
Authorized Official - Last Name:ANCONA
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:513-791-4500
Mailing Address - Street 1:9200 MONTGOMERY RD
Mailing Address - Street 2:BUILDING G, SUITE 20-B
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45242-7789
Mailing Address - Country:US
Mailing Address - Phone:513-791-4500
Mailing Address - Fax:513-791-6094
Practice Address - Street 1:9200 MONTGOMERY RD
Practice Address - Street 2:BUILDING G, SUITE 20-B
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45242-7789
Practice Address - Country:US
Practice Address - Phone:513-791-4500
Practice Address - Fax:513-791-6094
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH137771223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty