Provider Demographics
NPI:1437715612
Name:EAST MAIN DENTAL
Entity Type:Organization
Organization Name:EAST MAIN DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTY
Authorized Official - Middle Name:
Authorized Official - Last Name:MANRING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:614-876-8766
Mailing Address - Street 1:6810 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:REYNOLDSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:43068-2268
Mailing Address - Country:US
Mailing Address - Phone:614-866-6338
Mailing Address - Fax:614-575-9514
Practice Address - Street 1:1549 BRICE RD
Practice Address - Street 2:
Practice Address - City:REYNOLDSBURG
Practice Address - State:OH
Practice Address - Zip Code:43068-2307
Practice Address - Country:US
Practice Address - Phone:614-866-6338
Practice Address - Fax:614-575-9514
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-14
Last Update Date:2019-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty