Provider Demographics
NPI:1861663551
Name:FAMILY DENTISTRY
Entity Type:Organization
Organization Name:FAMILY DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:WAMDA
Authorized Official - Middle Name:L
Authorized Official - Last Name:HOOD
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:513-541-5599
Mailing Address - Street 1:PO BOX 36427
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45236-0427
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2310 BALTIMORE AVE
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45225
Practice Address - Country:US
Practice Address - Phone:513-541-5599
Practice Address - Fax:513-541-5599
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-20
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0762447Medicaid
0002833OtherAMERIGROUP-OHIO
OH0762447Medicaid