Provider Demographics
NPI:1649241787
Name:UNIVERSITY SURGICAL-DENTAL ASSOCIATES, LLC
Entity Type:Organization
Organization Name:UNIVERSITY SURGICAL-DENTAL ASSOCIATES, LLC
Other - Org Name:UNIVERSITY SURGICAL DENTAL ASSOCIATES, INC.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:EXECUTIVE VP/CFO
Authorized Official - Prefix:
Authorized Official - First Name:HUGH
Authorized Official - Middle Name:
Authorized Official - Last Name:HINDS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:513-585-8720
Mailing Address - Street 1:3200 BURNET AVE
Mailing Address - Street 2:3 SOUTH, CREDENTIALING
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45229-3019
Mailing Address - Country:US
Mailing Address - Phone:513-585-5502
Mailing Address - Fax:513-585-5511
Practice Address - Street 1:222 PIEDMONT AVE.
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45219-4231
Practice Address - Country:US
Practice Address - Phone:513-475-8783
Practice Address - Fax:513-475-7698
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-27
Last Update Date:2019-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial SurgeryGroup - Multi-Specialty
No122300000XDental ProvidersDentistGroup - Multi-Specialty
No1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0404048Medicaid
OHUN9249971Medicare PIN