Provider Demographics
NPI:1992508097
Name:ANTHONY DENTAL CARE - SOUTH HIGH LLC
Entity type:Organization
Organization Name:ANTHONY DENTAL CARE - SOUTH HIGH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OM
Authorized Official - Prefix:
Authorized Official - First Name:TRACEY
Authorized Official - Middle Name:
Authorized Official - Last Name:RECKNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:740-965-4090
Mailing Address - Street 1:257 W GRANVILLE ST STE 200
Mailing Address - Street 2:
Mailing Address - City:SUNBURY
Mailing Address - State:OH
Mailing Address - Zip Code:43074-9684
Mailing Address - Country:US
Mailing Address - Phone:740-965-4090
Mailing Address - Fax:740-965-9921
Practice Address - Street 1:3476 S HIGH ST
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43207-4007
Practice Address - Country:US
Practice Address - Phone:740-965-4090
Practice Address - Fax:740-965-9921
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-04-01
Last Update Date:2025-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty