Provider Demographics
NPI:1679780282
Name:GREG L. OFFENBURGER, D.D.S., INC.
Entity Type:Organization
Organization Name:GREG L. OFFENBURGER, D.D.S., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GREG
Authorized Official - Middle Name:L
Authorized Official - Last Name:OFFENBURGER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:614-268-4730
Mailing Address - Street 1:1495 MORSE RD
Mailing Address - Street 2:SUITE 205
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43229-6478
Mailing Address - Country:US
Mailing Address - Phone:614-268-4730
Mailing Address - Fax:
Practice Address - Street 1:1495 MORSE RD
Practice Address - Street 2:SUITE 205
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43229-6478
Practice Address - Country:US
Practice Address - Phone:614-268-4730
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-16
Last Update Date:2008-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OF0565951Medicare PIN