Provider Demographics
NPI:1962204453
Name:GADDIS FAMILY DENTAL LLC
Entity type:Organization
Organization Name:GADDIS FAMILY DENTAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSHUA
Authorized Official - Middle Name:W
Authorized Official - Last Name:GADDIS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:740-684-0302
Mailing Address - Street 1:421 NEW ENGLAND HILL RD
Mailing Address - Street 2:
Mailing Address - City:SHAWNEE
Mailing Address - State:OH
Mailing Address - Zip Code:43782-9736
Mailing Address - Country:US
Mailing Address - Phone:740-684-0302
Mailing Address - Fax:
Practice Address - Street 1:104 S MAIN ST
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:OH
Practice Address - Zip Code:43105-1426
Practice Address - Country:US
Practice Address - Phone:740-500-4746
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-03-25
Last Update Date:2025-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental