Provider Demographics
NPI:1194578583
Name:WESTERVILLE OFFICE PARKWAY FAMILY DENTISTRY LLC
Entity type:Organization
Organization Name:WESTERVILLE OFFICE PARKWAY FAMILY DENTISTRY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:OPAL
Authorized Official - Middle Name:
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:614-890-3338
Mailing Address - Street 1:33300 WARREN RD STE 29
Mailing Address - Street 2:
Mailing Address - City:WESTLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48185-9627
Mailing Address - Country:US
Mailing Address - Phone:614-890-3338
Mailing Address - Fax:
Practice Address - Street 1:598 OFFICE PKWY STE A
Practice Address - Street 2:
Practice Address - City:WESTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:43082-8077
Practice Address - Country:US
Practice Address - Phone:641-890-3338
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-08
Last Update Date:2024-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental