Provider Demographics
NPI:1942510268
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:740-333-7290
Mailing Address - Street 1:1387 LEESBURG AVE
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON COURT HOUSE
Mailing Address - State:OH
Mailing Address - Zip Code:43160-8655
Mailing Address - Country:US
Mailing Address - Phone:740-333-7290
Mailing Address - Fax:740-333-7291
Practice Address - Street 1:1387 LEESBURG AVE
Practice Address - Street 2:
Practice Address - City:WASHINGTON COURT HOUSE
Practice Address - State:OH
Practice Address - Zip Code:43160-8655
Practice Address - Country:US
Practice Address - Phone:740-333-7290
Practice Address - Fax:740-333-7291
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-20
Last Update Date:2010-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH218211223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty