Provider Demographics
NPI:1558419648
Name:SANJEEV GOEL, DDS, INC, OPR.
Entity Type:Organization
Organization Name:SANJEEV GOEL, DDS, INC, OPR.
Other - Org Name:DAYTON DENTAL & ORTHODONTICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SANJEEV
Authorized Official - Middle Name:
Authorized Official - Last Name:GOEL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:937-433-1494
Mailing Address - Street 1:2700 MIAMISBURG CENTERVILLE ROAD
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45459
Mailing Address - Country:US
Mailing Address - Phone:937-433-1494
Mailing Address - Fax:937-433-7763
Practice Address - Street 1:2700 MIAMISBURG CENTERVILLE ROAD
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45459
Practice Address - Country:US
Practice Address - Phone:937-433-1494
Practice Address - Fax:937-433-7763
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2166150Medicaid