Provider Demographics
NPI:1699182501
Name:DAYTON DENTAL SPECIALTIES
Entity Type:Organization
Organization Name:DAYTON DENTAL SPECIALTIES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SANJEEV
Authorized Official - Middle Name:K
Authorized Official - Last Name:GOEL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:513-942-8181
Mailing Address - Street 1:4235 INDIAN RIPPLE RD
Mailing Address - Street 2:SUITE 200A
Mailing Address - City:BEAVERCREEK
Mailing Address - State:OH
Mailing Address - Zip Code:45440-3284
Mailing Address - Country:US
Mailing Address - Phone:937-802-0901
Mailing Address - Fax:937-802-0950
Practice Address - Street 1:4235 INDIAN RIPPLE RD
Practice Address - Street 2:SUITE 200A
Practice Address - City:BEAVERCREEK
Practice Address - State:OH
Practice Address - Zip Code:45440-3284
Practice Address - Country:US
Practice Address - Phone:937-802-0901
Practice Address - Fax:937-802-0950
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-14
Last Update Date:2014-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH229791223E0200X
OH241251223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Multi-Specialty
No1223E0200XDental ProvidersDentistEndodonticsGroup - Multi-Specialty