Provider Demographics
NPI:1972620276
Name:KNO-HO-CO ASHLAND C.A.C
Entity Type:Organization
Organization Name:KNO-HO-CO ASHLAND C.A.C
Other - Org Name:ASHLAND DENTAL CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ASHLAND DENTAL CLINIC DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:KATHY
Authorized Official - Middle Name:RENEE'
Authorized Official - Last Name:BREITINGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:419-289-4957
Mailing Address - Street 1:1797 SEDDON CT
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:OH
Mailing Address - Zip Code:44805-3583
Mailing Address - Country:US
Mailing Address - Phone:419-289-4957
Mailing Address - Fax:419-282-6987
Practice Address - Street 1:1797 SEDDON CT
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:OH
Practice Address - Zip Code:44805-3583
Practice Address - Country:US
Practice Address - Phone:419-289-4957
Practice Address - Fax:419-282-6987
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-23
Last Update Date:2020-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223D0001XDental ProvidersDentistDental Public HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2106401Medicaid