Provider Demographics
NPI:1588836423
Name:OHIO URGENT DENTAL CARE
Entity Type:Organization
Organization Name:OHIO URGENT DENTAL CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CARLA
Authorized Official - Middle Name:
Authorized Official - Last Name:COMER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:614-875-7070
Mailing Address - Street 1:4050 GANTZ RD
Mailing Address - Street 2:
Mailing Address - City:GROVE CITY
Mailing Address - State:OH
Mailing Address - Zip Code:43123-4816
Mailing Address - Country:US
Mailing Address - Phone:614-875-7070
Mailing Address - Fax:614-875-0707
Practice Address - Street 1:4050 GANTZ RD
Practice Address - Street 2:
Practice Address - City:GROVE CITY
Practice Address - State:OH
Practice Address - Zip Code:43123-4816
Practice Address - Country:US
Practice Address - Phone:614-875-7070
Practice Address - Fax:614-875-0707
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-01
Last Update Date:2011-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30-018619122300000X
OH30-020907122300000X
OH30.023283122300000X
OH30-023335122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2699110Medicaid