Provider Demographics
NPI:1548596752
Name:SOUTHWOOD, DAVID P, (DMD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:P,
Last Name:SOUTHWOOD
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3557 SPRINGDALE RD
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45251-1314
Mailing Address - Country:US
Mailing Address - Phone:513-385-5400
Mailing Address - Fax:513-385-5400
Practice Address - Street 1:3557 SPRINGDALE RD
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45251-1314
Practice Address - Country:US
Practice Address - Phone:513-385-5400
Practice Address - Fax:513-385-5400
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-22
Last Update Date:2009-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH176911223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice