Cincy Pediatric Dentistry, LLC

Primary specialty

Pediatric DentistryTaxonomy code 1223P0221X

Legal business name

CINCY PEDIATRIC DENTISTRY, LLC

Practice address

7777 Yankee Rd
Liberty Township, OH 45044-3500

Phone

(937) 245-0390

NPI assigned

Jan 9, 2020

Organization subpart

No

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

Authorized official

Name

Lisa Marie Rudolph, D.M.D

Title

Pediatric Dentist

Phone

(513) 400-8551

Specialties & licenses 1

Addresses

Practitioners 1

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

• Petr Alexander Vaughan

  • Pediatric Dentistry
  • Cincinnati, OH
  • NPI 1316576556
  NPD

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

{
    "created_epoch": "1578528000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1677456000000",
    "number": "1912547811",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1131 CRYER AVE",
            "city": "CINCINNATI",
            "state": "OH",
            "postal_code": "45208",
            "telephone_number": "513-400-8551"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7777 YANKEE RD",
            "city": "LIBERTY TOWNSHIP",
            "state": "OH",
            "postal_code": "450443500",
            "telephone_number": "937-245-0390"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1131 Cryer Ave",
            "address_purpose": "LOCATION",
            "city": "Cincinnati",
            "state": "OH",
            "postal_code": "45208",
            "country_code": "US",
            "telephone_number": "513-400-8551",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "CINCY PEDIATRIC DENTISTRY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-01-09",
        "last_updated": "2023-02-27",
        "certification_date": "2023-02-27",
        "status": "A",
        "authorized_official_last_name": "RUDOLPH",
        "authorized_official_first_name": "LISA",
        "authorized_official_middle_name": "MARIE",
        "authorized_official_title_or_position": "PEDIATRIC DENTIST",
        "authorized_official_telephone_number": "513-400-8551",
        "authorized_official_credential": "D.M.D"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Pediatric Dentistry",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Children'S Hospital Medical Center
• Kelly Louise Christian
• CHS of Southern Ohio
• Cimarron Dialysis LLC
• Cincinnati Vision Group LLC
• Erica Marie Collins, CHT
• Combs Family Eyecare LLC
• Alicia M Combs, O.D.
• Sherry J Conlin
• Heather Ann Connor, LISW

• Pediatric Dentistry in Liberty Township, OH
• Providers in Liberty Township, OH by specialty
• Pediatric Dentistry in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 27, 2023; 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.