Provider Demographics
NPI:1891012720
Name:OPTIMAL FAMILY DENTAL LLC
Entity Type:Organization
Organization Name:OPTIMAL FAMILY DENTAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MEERA
Authorized Official - Middle Name:
Authorized Official - Last Name:THUNGA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:513-770-0063
Mailing Address - Street 1:969 READING RD
Mailing Address - Street 2:SUITE J
Mailing Address - City:MASON
Mailing Address - State:OH
Mailing Address - Zip Code:45040-2654
Mailing Address - Country:US
Mailing Address - Phone:513-770-0063
Mailing Address - Fax:513-770-0102
Practice Address - Street 1:969 READING RD
Practice Address - Street 2:SUITE J
Practice Address - City:MASON
Practice Address - State:OH
Practice Address - Zip Code:45040-2654
Practice Address - Country:US
Practice Address - Phone:513-770-0063
Practice Address - Fax:513-770-0102
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-03
Last Update Date:2021-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH218271223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2458273Medicaid