Provider Demographics
NPI:1467200444
Name:SHILOH DENTAL SERVICES, LLC
Entity type:Organization
Organization Name:SHILOH DENTAL SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:CHAD
Authorized Official - Middle Name:A
Authorized Official - Last Name:KAUFMAN
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C
Authorized Official - Phone:419-908-8003
Mailing Address - Street 1:5748 STATE ROUTE 13
Mailing Address - Street 2:
Mailing Address - City:GREENWICH
Mailing Address - State:OH
Mailing Address - Zip Code:44837-9308
Mailing Address - Country:US
Mailing Address - Phone:419-908-8003
Mailing Address - Fax:567-203-5482
Practice Address - Street 1:5748 STATE ROUTE 13
Practice Address - Street 2:
Practice Address - City:GREENWICH
Practice Address - State:OH
Practice Address - Zip Code:44837-9308
Practice Address - Country:US
Practice Address - Phone:419-908-8003
Practice Address - Fax:567-203-5482
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SHILOH MEDICAL SERVICES, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-05-07
Last Update Date:2024-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty