Provider Demographics
NPI:1275627242
Name:ROSEHILL DENTAL CENTER - M. DANEAULT JR DDS LLC
Entity Type:Organization
Organization Name:ROSEHILL DENTAL CENTER - M. DANEAULT JR DDS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST / OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARCEL
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:DANEAULT
Authorized Official - Suffix:JR
Authorized Official - Credentials:DDS
Authorized Official - Phone:614-751-9306
Mailing Address - Street 1:PO BOX 240
Mailing Address - Street 2:1338 ROSEHILL ROAD
Mailing Address - City:REYNOLDSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:43068-0240
Mailing Address - Country:US
Mailing Address - Phone:614-751-9306
Mailing Address - Fax:614-751-9307
Practice Address - Street 1:1338 ROSEHILL ROAD
Practice Address - Street 2:
Practice Address - City:REYNOLDSBURG
Practice Address - State:OH
Practice Address - Zip Code:43068-0240
Practice Address - Country:US
Practice Address - Phone:614-751-9306
Practice Address - Fax:614-751-9307
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-03
Last Update Date:2007-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH21432122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty