Provider Demographics
NPI:1831621069
Name:HOBAN, MACKENZIE
Entity type:Individual
Prefix:
First Name:MACKENZIE
Middle Name:
Last Name:HOBAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:MACK
Other - Middle Name:
Other - Last Name:HOBAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:231 ALBERT SABIN WAY
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45267-0769
Mailing Address - Country:US
Mailing Address - Phone:513-584-6660
Mailing Address - Fax:513-584-6661
Practice Address - Street 1:234 GOODMAN ST
Practice Address - Street 2:UCMC DENTAL CENTER
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45219-2364
Practice Address - Country:US
Practice Address - Phone:513-584-6660
Practice Address - Fax:513-584-6661
Is Sole Proprietor?:No
Enumeration Date:2017-03-28
Last Update Date:2019-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30.0253471223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice