Organization
EDGEWOOD DENTAL CLINIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. RAYMOND R THENOT (OWNER)
(513) 868-9277
Entity
Organization
Contact information
Practice address
1 SOUTH EDGEWOOD AVE, HAMILTON, OH 45013-2505
(513) 868-9277
(513) 868-9277
Mailing address
1 SOUTH EDGEWOOD AVE, HAMILTON, OH 45013-2505
(513) 868-9277
(513) 868-9277
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
30011994
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
30011994
LICENSE NUMBER
—
Enumeration date
05/25/2007
Last updated
08/22/2020
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