Provider Demographics
NPI:1194370494
Name:WALNUT CREEK DENTAL EAST, MICHAEL PAPPAS, DDS, LLC
Entity type:Organization
Organization Name:WALNUT CREEK DENTAL EAST, MICHAEL PAPPAS, DDS, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:PAPPAS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:614-864-7466
Mailing Address - Street 1:1387 LEESBURG AVE
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON COURT HOUSE
Mailing Address - State:OH
Mailing Address - Zip Code:43160-8655
Mailing Address - Country:US
Mailing Address - Phone:740-333-7290
Mailing Address - Fax:740-333-7291
Practice Address - Street 1:3803 S HAMILTON RD
Practice Address - Street 2:
Practice Address - City:GROVEPORT
Practice Address - State:OH
Practice Address - Zip Code:43125-9330
Practice Address - Country:US
Practice Address - Phone:614-864-2466
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-05
Last Update Date:2019-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty