Provider Demographics
NPI:1821394180
Name:FAMILY DENTAL CARE
Entity Type:Organization
Organization Name:FAMILY DENTAL CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ALI
Authorized Official - Middle Name:
Authorized Official - Last Name:KHAKSARFARD
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:740-852-7741
Mailing Address - Street 1:1248 COLUMBUS AVE
Mailing Address - Street 2:SUITE 8
Mailing Address - City:LEBANON
Mailing Address - State:OH
Mailing Address - Zip Code:45036-8363
Mailing Address - Country:US
Mailing Address - Phone:513-932-0432
Mailing Address - Fax:513-932-0532
Practice Address - Street 1:1248 COLUMBUS AVE
Practice Address - Street 2:SUITE 8
Practice Address - City:LEBANON
Practice Address - State:OH
Practice Address - Zip Code:45036-8363
Practice Address - Country:US
Practice Address - Phone:513-932-0432
Practice Address - Fax:513-932-0532
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-03
Last Update Date:2011-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty