Provider Demographics
NPI:1518912831
Name:PEDIATRIC DENTAL ASSOCIATES OF WEST CHESTER
Entity Type:Organization
Organization Name:PEDIATRIC DENTAL ASSOCIATES OF WEST CHESTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:KOREN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:513-777-2313
Mailing Address - Street 1:9215 CINCINNATI COLUMBUS RD
Mailing Address - Street 2:
Mailing Address - City:WEST CHESTER
Mailing Address - State:OH
Mailing Address - Zip Code:45069-4143
Mailing Address - Country:US
Mailing Address - Phone:513-777-2313
Mailing Address - Fax:513-779-5942
Practice Address - Street 1:9215 CINCINNATI COLUMBUS RD
Practice Address - Street 2:
Practice Address - City:WEST CHESTER
Practice Address - State:OH
Practice Address - Zip Code:45069-4143
Practice Address - Country:US
Practice Address - Phone:513-777-2313
Practice Address - Fax:513-779-5942
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-24
Last Update Date:2008-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH300144421223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty