Organization
HAMILTON RIVERSIDE DENTISTRY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DAVID T TANKOVICH (OPERATIONS DIRECTOR)
(513) 868-0200
Entity
Organization
Contact information
Practice address
112 N. SECOND ST, HAMILTON, OH 45011
(513) 868-0200
Mailing address
112 N 2ND ST, HAMILTON, OH 45011-2702
(513) 868-0200
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
30019324
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0106920
—
OH
Enumeration date
07/15/2014
Last updated
12/08/2014
Update your record
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