Provider Demographics
NPI:1245986041
Name:DOAN DENTAL LLC
Entity type:Organization
Organization Name:DOAN DENTAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:HIEU
Authorized Official - Middle Name:
Authorized Official - Last Name:DOAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:239-216-6687
Mailing Address - Street 1:1413 PINNACLE CLUB DR
Mailing Address - Street 2:
Mailing Address - City:GROVE CITY
Mailing Address - State:OH
Mailing Address - Zip Code:43123-8371
Mailing Address - Country:US
Mailing Address - Phone:239-216-6687
Mailing Address - Fax:
Practice Address - Street 1:15580 US HIGHWAY 36
Practice Address - Street 2:
Practice Address - City:MARYSVILLE
Practice Address - State:OH
Practice Address - Zip Code:43040-9415
Practice Address - Country:US
Practice Address - Phone:937-707-1111
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-01
Last Update Date:2022-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH1326603184Medicaid