NPIMap

Organization Active NPI

Ohio Dental Professionals, Delisle, PC

  • General Practice Dentistry
  • Reynoldsburg, OH
National Provider Identifier
1992197883
Registry record updated Mar 4, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
30024311 Issued in OH
Legal business name
OHIO DENTAL PROFESSIONALS, DELISLE, PC
Practice address
8086 E Broad St
Reynoldsburg, OH 43068
Phone
(614) 328-9661
NPI assigned
Mar 2, 2015
Organization subpart
Yes
Parent organization
OHIO DENTAL PROFESSIONALS, DELISLE, PCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Mar 4, 2015

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

Authorized official

Name
Kendra Walker
Title
Credentialing Coordinator
Phone
(217) 540-8312

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X 30024311 OH Primary

Addresses

Primary practice location

8086 E Broad St
Reynoldsburg, OH 43068

Mailing address

8086 E Broad St
Reynoldsburg, OH 43068-8024
Phone (614) 328-9661

Other names 1

  • East Broad Family Dentistry Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Heartland Dental Care of Oh Richard E Workman DMD PS39 organizations share this tax ID, including this one
Part of
Heartland Dental Care of Oh Richard E Workman DMD PS

Other organizations with this tax ID 38

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

View all 38

Locations

8086 E Broad St
Reynoldsburg, OH 43068
Phone (614) 328-9661

NPI Registry JSON

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

{
    "created_epoch": "1425254400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1425427200000",
    "number": "1992197883",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8086 E BROAD ST",
            "city": "REYNOLDSBURG",
            "state": "OH",
            "postal_code": "430688024",
            "telephone_number": "614-328-9661"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8086 E BROAD ST",
            "city": "REYNOLDSBURG",
            "state": "OH",
            "postal_code": "43068",
            "telephone_number": "614-328-9661"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OHIO DENTAL PROFESSIONALS, DELISLE, PC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "OHIO DENTAL PROFESSIONALS, DELISLE, PC",
        "enumeration_date": "2015-03-02",
        "last_updated": "2015-03-04",
        "status": "A",
        "authorized_official_last_name": "WALKER",
        "authorized_official_first_name": "KENDRA",
        "authorized_official_title_or_position": "CREDENTIALING COORDINATOR",
        "authorized_official_telephone_number": "217-540-8312"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "OH",
            "license": "30024311",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "East Broad Family Dentistry",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Reynoldsburg, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 4, 2015; 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.