Provider Demographics
NPI:1194200717
Name:KIDS DENTAL OF DAYTON-JOAN-FLORENCE BESANA SALIDO DDS INC
Entity type:Organization
Organization Name:KIDS DENTAL OF DAYTON-JOAN-FLORENCE BESANA SALIDO DDS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SR CREDENTIALING SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:MAGDALENA
Authorized Official - Middle Name:
Authorized Official - Last Name:EVANS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:720-603-4763
Mailing Address - Street 1:4257 W 3RD ST
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45417-1406
Mailing Address - Country:US
Mailing Address - Phone:937-268-1665
Mailing Address - Fax:
Practice Address - Street 1:4257 W 3RD ST
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45417-1406
Practice Address - Country:US
Practice Address - Phone:937-268-1665
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-28
Last Update Date:2024-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty