Provider Demographics
NPI:1386152452
Name:COMPLETE HEALTH DENTISTRY OF CINCINNATI
Entity type:Organization
Organization Name:COMPLETE HEALTH DENTISTRY OF CINCINNATI
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:D
Authorized Official - Last Name:HENIZE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:513-489-0607
Mailing Address - Street 1:4723 CORNELL RD
Mailing Address - Street 2:
Mailing Address - City:BLUE ASH
Mailing Address - State:OH
Mailing Address - Zip Code:45241-7406
Mailing Address - Country:US
Mailing Address - Phone:513-489-0607
Mailing Address - Fax:513-657-0707
Practice Address - Street 1:4723 CORNELL RD
Practice Address - Street 2:
Practice Address - City:BLUE ASH
Practice Address - State:OH
Practice Address - Zip Code:45241-7406
Practice Address - Country:US
Practice Address - Phone:513-489-0607
Practice Address - Fax:513-657-0707
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ERIC D HENIZE DDS, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-01-11
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3016838261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental