Provider Demographics
NPI: | 1477822013 |
---|---|
Name: | UDC OF WEST CHESTER, LLC |
Entity Type: | Organization |
Organization Name: | UDC OF WEST CHESTER, LLC |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | PRESIDENT |
Authorized Official - Prefix: | DR |
Authorized Official - First Name: | JOSEPH |
Authorized Official - Middle Name: | J |
Authorized Official - Last Name: | BROWN |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | DMD |
Authorized Official - Phone: | 513-777-7883 |
Mailing Address - Street 1: | 9464 CIVIC CENTRE BLVD |
Mailing Address - Street 2: | |
Mailing Address - City: | WEST CHESTER |
Mailing Address - State: | OH |
Mailing Address - Zip Code: | 45069 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 513-777-7883 |
Mailing Address - Fax: | 513-755-1604 |
Practice Address - Street 1: | 9464 CIVIC CENTRE BLVD |
Practice Address - Street 2: | |
Practice Address - City: | WEST CHESTER |
Practice Address - State: | OH |
Practice Address - Zip Code: | 45069 |
Practice Address - Country: | US |
Practice Address - Phone: | 513-777-7883 |
Practice Address - Fax: | 513-755-1604 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2011-12-28 |
Last Update Date: | 2011-12-28 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
KY | 1223G0001X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 1223G0001X | Dental Providers | Dentist | General Practice | Group - Multi-Specialty |