Edgewood Dental Clinic

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

30011994 Issued in OH

Legal business name

EDGEWOOD DENTAL CLINIC

Practice address

1 South Edgewood Ave
Hamilton, OH 45013-2505

Phone

(513) 868-9277

Fax

(513) 868-9277

NPI assigned

May 25, 2007

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Raymond R Thenot

Title

Owner

Phone

(513) 868-9277

Specialties & licenses 1

Addresses

Other identifiers 1

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1180051200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1194936724",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 SOUTH EDGEWOOD AVE",
            "city": "HAMILTON",
            "state": "OH",
            "postal_code": "450132505",
            "telephone_number": "513-868-9277",
            "fax_number": "513-868-9277"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 SOUTH EDGEWOOD AVE",
            "city": "HAMILTON",
            "state": "OH",
            "postal_code": "450132505",
            "telephone_number": "513-868-9277",
            "fax_number": "513-868-9277"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EDGEWOOD DENTAL CLINIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-25",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "THENOT",
        "authorized_official_first_name": "RAYMOND",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "513-868-9277",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "OH",
            "license": "30011994",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE NUMBER",
            "identifier": "30011994",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.