Basic Information
| Provider Information | |||||||||
| NPI: | 1194200717 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | KIDS DENTAL OF DAYTON-JOAN-FLORENCE BESANA SALIDO DDS INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4257 W 3RD ST | ||||||||
| Address2: | |||||||||
| City: | DAYTON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 454171406 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9372681665 | ||||||||
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| Practice Location | |||||||||
| Address1: | 4257 W 3RD ST | ||||||||
| Address2: | |||||||||
| City: | DAYTON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 454171406 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9372681665 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/28/2018 | ||||||||
| LastUpdateDate: | 12/26/2018 | ||||||||
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| AuthorizedOfficialLastName: | BURTON | ||||||||
| AuthorizedOfficialFirstName: | DIANA | ||||||||
| AuthorizedOfficialMiddleName: | R | ||||||||
| AuthorizedOfficialTitleorPosition: | OPERATIONS MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 7206034763 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1223G0001X | Y | 193400000X SINGLE SPECIALTY GROUP | Dental Providers | Dentist | General Practice |
No ID Information.