Provider Demographics
NPI:1740396530
Name:ERNDT YONCHAK & AGARWALA DDS MS INC
Entity Type:Organization
Organization Name:ERNDT YONCHAK & AGARWALA DDS MS INC
Other - Org Name:ERNDT YONCHAK & HALCOMB DDS MS INC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:A
Authorized Official - Last Name:YONCHAK
Authorized Official - Suffix:JR
Authorized Official - Credentials:DDS MS
Authorized Official - Phone:513-424-5630
Mailing Address - Street 1:150 N BREIEL BLVD
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:OH
Mailing Address - Zip Code:45042
Mailing Address - Country:US
Mailing Address - Phone:513-424-5630
Mailing Address - Fax:513-424-0230
Practice Address - Street 1:150 N BREIEL BLVD
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:OH
Practice Address - Zip Code:45042
Practice Address - Country:US
Practice Address - Phone:513-424-5630
Practice Address - Fax:513-424-0230
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOHH156901223E0200X
OHOH183061223E0200X
OHOH216981223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Multi-Specialty