Marysville Dental Group

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

Legal business name

MARYSVILLE DENTAL GROUP

Practice address

17791 State Route 31
Marysville, OH 43040-9607

Phone

(937) 578-0014

Fax

(937) 644-0660

NPI assigned

Aug 30, 2019

Organization subpart

No

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

Authorized official

Name

Maher Soudah

Title

Ceo

Phone

(937) 578-0014

Specialties & licenses 1

Addresses

Other names 1

• Khouri Dental Care, LLC Doing business as

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

{
    "created_epoch": "1567123200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1567209600000",
    "number": "1386292530",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17791 STATE ROUTE 31",
            "city": "MARYSVILLE",
            "state": "OH",
            "postal_code": "430409607",
            "telephone_number": "937-578-0014",
            "fax_number": "937-644-0660"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17791 STATE ROUTE 31",
            "city": "MARYSVILLE",
            "state": "OH",
            "postal_code": "430409607",
            "telephone_number": "937-578-0014",
            "fax_number": "937-644-0660"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARYSVILLE DENTAL GROUP",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-08-30",
        "last_updated": "2019-08-31",
        "status": "A",
        "authorized_official_last_name": "SOUDAH",
        "authorized_official_first_name": "MAHER",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "937-578-0014"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Khouri Dental Care, LLC",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Khouri Dental Care, LLC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Mackenzie Elizabeth Marquis, LSW
• Justin Marsh
• Molly Martin
• Danielle Theresa Martter, MD
• Marysville Arthritis Center, LLC
• Marysville Emergency Physicians Inc.
• Marysville Endodontics, LLC
• Marysville Exempted Village School District
• Marysville Family Dentistry-Matthew Scurria, DDS, LLC
• Marysville Obstetrics and Gynecology Inc.

• General Practice Dentistry in Marysville, OH
• Providers in Marysville, OH by specialty
• General Practice Dentistry in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 31, 2019; 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.