Provider Demographics
NPI:1508690991
Name:GRACEFUL GRINS PEDIATRIC DENTISTRY
Entity type:Organization
Organization Name:GRACEFUL GRINS PEDIATRIC DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PEDIATRIC DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:IVORY
Authorized Official - Middle Name:
Authorized Official - Last Name:WARD
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:513-824-8886
Mailing Address - Street 1:5729 ROE ST
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45227-2227
Mailing Address - Country:US
Mailing Address - Phone:856-425-9256
Mailing Address - Fax:
Practice Address - Street 1:7915 E KEMPER RD
Practice Address - Street 2:UNIT B
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45249
Practice Address - Country:US
Practice Address - Phone:513-824-8886
Practice Address - Fax:513-824-9774
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-28
Last Update Date:2024-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty