Provider Demographics
NPI:1639229735
Name:PARK DENTAL CARE OF HAMILTON OH INC
Entity Type:Organization
Organization Name:PARK DENTAL CARE OF HAMILTON OH INC
Other - Org Name:PAUL W GRIESELHUBER AND RENE W GRIESELHUBER DDS INC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFERY
Authorized Official - Middle Name:KARL
Authorized Official - Last Name:LEIBFORTH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:513-896-7979
Mailing Address - Street 1:345 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:HAMILTON
Mailing Address - State:OH
Mailing Address - Zip Code:45013-3078
Mailing Address - Country:US
Mailing Address - Phone:513-896-7979
Mailing Address - Fax:513-896-1081
Practice Address - Street 1:345 PARK AVE
Practice Address - Street 2:
Practice Address - City:HAMILTON
Practice Address - State:OH
Practice Address - Zip Code:45013-3078
Practice Address - Country:US
Practice Address - Phone:513-896-7979
Practice Address - Fax:513-896-1081
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-11
Last Update Date:2014-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH154711223G0001X
OH143791223G0001X
OH118131223G0001X
OH211761223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty