Provider Demographics
NPI:1699004218
Name:DEVER DENTAL LLC
Entity Type:Organization
Organization Name:DEVER DENTAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARTHA
Authorized Official - Middle Name:GERDSEN
Authorized Official - Last Name:DEVER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:513-777-6444
Mailing Address - Street 1:9144 CINCINNATI COLUMBUS RD
Mailing Address - Street 2:
Mailing Address - City:WEST CHESTER
Mailing Address - State:OH
Mailing Address - Zip Code:45069-3702
Mailing Address - Country:US
Mailing Address - Phone:513-777-6444
Mailing Address - Fax:
Practice Address - Street 1:9144 CINCINNATI COLUMBUS RD
Practice Address - Street 2:
Practice Address - City:WEST CHESTER
Practice Address - State:OH
Practice Address - Zip Code:45069-3702
Practice Address - Country:US
Practice Address - Phone:513-777-6444
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-10
Last Update Date:2009-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30-022401261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental