NPIMap

CD Ohio Derrick Kruger DDS, Inc.

Organization Active NPI General Practice Dentistry · Blue Ash, OH

NPI 1699259606 · NPPES record last updated Jan 6, 2023

Key facts

NPI
1699259606
Entity type
Organization (NPI type 2)
Primary specialty
General Practice Dentistry 1223G0001X
Legal business name
CD OHIO DERRICK KRUGER DDS, INC.
Practice address
4157 Hunt Rd
Blue Ash, OH 45236-1158
Phone
(513) 791-6154
Fax
(513) 791-1449
NPI assigned
Sep 17, 2018
Organization subpart
No

Authorized official

Name
Ty Justice
Title
Director, Credentialing & Payer Rel
Phone
(513) 808-4984

Corporate family (same tax ID) 3

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

National Provider Directory

Tax ID family
CD Ohio Derrick Kruger DDS Inc (4 organizations share this tax ID)

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist
Group: 193200000X MULTI-SPECIALTY GROUP		 122300000X
General Practice Dentistry
Group: 193200000X MULTI-SPECIALTY GROUP		 1223G0001X Yes

Addresses

Primary practice location

4157 Hunt Rd
Blue Ash, OH 45236-1158

Mailing address

9825 Kenwood Rd Ste 200
Blue Ash, OH 45242-6252
Phone (513) 808-4984

Other names

  • Family Dentistry of Blue Ash Doing business as

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Jan 6, 2023.

{
    "created_epoch": "1537142400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1672963200000",
    "number": "1699259606",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9825 KENWOOD RD STE 200",
            "city": "BLUE ASH",
            "state": "OH",
            "postal_code": "452426252",
            "telephone_number": "513-808-4984",
            "fax_number": "513-448-0511"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4157 HUNT RD",
            "city": "BLUE ASH",
            "state": "OH",
            "postal_code": "452361158",
            "telephone_number": "513-791-6154",
            "fax_number": "513-791-1449"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CD OHIO DERRICK KRUGER DDS, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-09-17",
        "last_updated": "2023-01-06",
        "certification_date": "2023-01-06",
        "status": "A",
        "authorized_official_last_name": "JUSTICE",
        "authorized_official_first_name": "TY",
        "authorized_official_title_or_position": "DIRECTOR, CREDENTIALING & PAYER REL",
        "authorized_official_telephone_number": "513-808-4984"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Family Dentistry of Blue Ash",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Blue Ash, OH

All providers in Blue Ash, OH · General Practice Dentistry in Ohio

Sources for this page

Verify at the official NPI Registry.