Provider Demographics
NPI:1306047675
Name:GERMANTOWN FAMILY DENTAL
Entity type:Organization
Organization Name:GERMANTOWN FAMILY DENTAL
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JONELL
Authorized Official - Middle Name:L
Authorized Official - Last Name:VOSKUHL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:937-376-9975
Mailing Address - Street 1:26 W CENTER ST
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:45327-1342
Mailing Address - Country:US
Mailing Address - Phone:937-855-7231
Mailing Address - Fax:
Practice Address - Street 1:26 W CENTER ST
Practice Address - Street 2:
Practice Address - City:GERMANTOWN
Practice Address - State:OH
Practice Address - Zip Code:45327-1342
Practice Address - Country:US
Practice Address - Phone:937-855-7231
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH181861223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty