Provider Demographics
NPI:1710562251
Name:KEEP SMILING DENTAL GROUP DRS. RODDY & PALM LLC
Entity Type:Organization
Organization Name:KEEP SMILING DENTAL GROUP DRS. RODDY & PALM LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SUE
Authorized Official - Middle Name:
Authorized Official - Last Name:RADER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:937-426-5340
Mailing Address - Street 1:4090 INDIAN RIPPLE RD STE 101
Mailing Address - Street 2:
Mailing Address - City:BEAVERCREEK
Mailing Address - State:OH
Mailing Address - Zip Code:45440-3292
Mailing Address - Country:US
Mailing Address - Phone:937-426-5340
Mailing Address - Fax:
Practice Address - Street 1:4090 INDIAN RIPPLE RD STE 101
Practice Address - Street 2:
Practice Address - City:BEAVERCREEK
Practice Address - State:OH
Practice Address - Zip Code:45440-3292
Practice Address - Country:US
Practice Address - Phone:937-426-5340
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-16
Last Update Date:2021-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1013089770OtherNPPES
OH30.019043OtherOHIO STATE DENTAL BOARD
1376034488OtherNPPES
OH30.025388OtherOHIO STATE DENTAL BOARD