Provider Demographics
NPI:1063734994
Name:MIDWEST URGENT DENTAL CARE
Entity type:Organization
Organization Name:MIDWEST URGENT DENTAL CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:J
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:513-777-7883
Mailing Address - Street 1:9464 CIVIC CENTRE BOULEVARD
Mailing Address - Street 2:
Mailing Address - City:WEST CHESTER
Mailing Address - State:OH
Mailing Address - Zip Code:45069
Mailing Address - Country:US
Mailing Address - Phone:513-777-7883
Mailing Address - Fax:513-755-1604
Practice Address - Street 1:9464 CIVIC CENTRE BOULEVARD
Practice Address - Street 2:
Practice Address - City:WEST CHESTER
Practice Address - State:OH
Practice Address - Zip Code:45069
Practice Address - Country:US
Practice Address - Phone:513-777-7883
Practice Address - Fax:513-755-1604
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-19
Last Update Date:2010-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH300231171223G0001X
OH300231351223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0856033Medicaid