Provider Demographics
NPI:1710365937
Name:AFFORDABLE DENTURES - FOREST PARK, MARK A. MECLOSKY, DDS, INC.
Entity Type:Organization
Organization Name:AFFORDABLE DENTURES - FOREST PARK, MARK A. MECLOSKY, DDS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DDS/PRACTICE OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:MECLOSKY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:513-648-9479
Mailing Address - Street 1:1173 SMILEY AVENUE
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45240
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1173 SMILEY AVENUE
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45240
Practice Address - Country:US
Practice Address - Phone:513-648-9479
Practice Address - Fax:513-648-9489
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-07
Last Update Date:2015-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30.018831122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty