Provider Demographics
NPI:1932100476
Name:GREAT MIAMI DENTAL ASSOCIATES INC.
Entity Type:Organization
Organization Name:GREAT MIAMI DENTAL ASSOCIATES INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:A
Authorized Official - Last Name:LANG
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:513-424-5349
Mailing Address - Street 1:130 N BREIEL BLVD
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:OH
Mailing Address - Zip Code:45042-3806
Mailing Address - Country:US
Mailing Address - Phone:513-424-5349
Mailing Address - Fax:513-424-4762
Practice Address - Street 1:130 N BREIEL BLVD
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:OH
Practice Address - Zip Code:45042-3806
Practice Address - Country:US
Practice Address - Phone:513-424-5349
Practice Address - Fax:513-424-4762
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30-01-89811223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty