Provider Demographics
NPI:1013526078
Name:ATHENS DENTAL DEPOT, MICHAEL D. GINDER DDS & COMPANY
Entity type:Organization
Organization Name:ATHENS DENTAL DEPOT, MICHAEL D. GINDER DDS & COMPANY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:TREASURER/CPA
Authorized Official - Prefix:
Authorized Official - First Name:ANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:CORNWELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:740-707-7838
Mailing Address - Street 1:80 COLUMBUS RD
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:OH
Mailing Address - Zip Code:45701-1312
Mailing Address - Country:US
Mailing Address - Phone:740-594-6000
Mailing Address - Fax:740-594-6025
Practice Address - Street 1:80 COLUMBUS RD
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:OH
Practice Address - Zip Code:45701-1312
Practice Address - Country:US
Practice Address - Phone:740-594-6000
Practice Address - Fax:740-594-6025
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-27
Last Update Date:2020-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No1223E0200XDental ProvidersDentistEndodonticsGroup - Multi-Specialty
No124Q00000XDental ProvidersDental HygienistGroup - Multi-Specialty