Provider Demographics
NPI:1720490873
Name:FENNELL, NATHAN ANDREWS (DDS)
Entity Type:Individual
Prefix:
First Name:NATHAN
Middle Name:ANDREWS
Last Name:FENNELL
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2819 LANGDON FARM RD
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45212-1349
Mailing Address - Country:US
Mailing Address - Phone:513-373-1115
Mailing Address - Fax:
Practice Address - Street 1:5451 MONTGOMERY RD
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45212-1708
Practice Address - Country:US
Practice Address - Phone:513-631-6600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-05-23
Last Update Date:2014-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30024178122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist