Provider Demographics
NPI:1629124052
Name:SMILE ZONE KIDS DENTISTRY
Entity Type:Organization
Organization Name:SMILE ZONE KIDS DENTISTRY
Other - Org Name:ROSELAWN SMILES YOUTH DENTISTRY LLC ELIZABETH GEIER DMD
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CELESTE
Authorized Official - Middle Name:
Authorized Official - Last Name:SESTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:513-841-1000
Mailing Address - Street 1:1860 SEYMOUR AVE
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45237-4002
Mailing Address - Country:US
Mailing Address - Phone:513-841-1000
Mailing Address - Fax:513-841-1004
Practice Address - Street 1:1860 SEYMOUR AVE
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45237-4002
Practice Address - Country:US
Practice Address - Phone:513-841-1000
Practice Address - Fax:513-841-1004
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-26
Last Update Date:2015-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH1764612OtherUNITED CONCORDIA
OH2551368Medicaid
KY5198006OtherAVESIS
KY61901161Medicaid
IN201006370AMedicaid
KY61901161Medicaid