# FAMILY DENTAL CARE AT EAGLETON CENTER

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1811170160
- **Authorized official:** DR. ALI KHAKSAFARD DDS (OWNER)
- **Authorized official phone:** (740) 852-7741

## Contact information

- **Practice address:** 391 LAFAYETTE ST., LONDON, OH 43140-9195
- **Practice address phone:** (740) 852-7741
- **Practice address fax:** (740) 852-7783
- **Mailing address:** 391 LAFAYETTE ST, LONDON, OH 43140-9326
- **Mailing address phone:** (740) 852-7741
- **Mailing address fax:** (740) 852-7783

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QD0000X | Dental Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 12/10/2007
- **Last updated:** 03/30/2017