Basic Information
| Provider Information | |||||||||
| NPI: | 1316336068 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | DUBLIN KIDS DENTAL | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6235 PERIMETER DR | ||||||||
| Address2: | SUITE A | ||||||||
| City: | DUBLIN | ||||||||
| State: | OH | ||||||||
| PostalCode: | 430177202 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3109025927 | ||||||||
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| Practice Location | |||||||||
| Address1: | 6235 PERIMETER DR | ||||||||
| Address2: | SUITE A | ||||||||
| City: | DUBLIN | ||||||||
| State: | OH | ||||||||
| PostalCode: | 430177202 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3109025927 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/19/2015 | ||||||||
| LastUpdateDate: | 01/19/2015 | ||||||||
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| AuthorizedOfficialLastName: | MATRACIA | ||||||||
| AuthorizedOfficialFirstName: | SOPHIE (YOON MI) | ||||||||
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| AuthorizedOfficialTitleorPosition: | PEDIATRIC DENTIST, OWNER | ||||||||
| AuthorizedOfficialTelephone: | 3109025927 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | DMD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1223P0221X | 30.022533 | OH | Y | 193400000X SINGLE SPECIALTY GROUP | Dental Providers | Dentist | Pediatric Dentistry |
No ID Information.