Organization
KNICKERBOCKER PEDIATRIC DENTISTRY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BETTY HUANG DDS (PRESIDENT)
(419) 463-0023
Entity
Organization
Contact information
Practice address
1 CHILDRENS PLZ, DAYTON, OH 45404-1873
(937) 619-9828
Mailing address
PO BOX 752144, DAYTON, OH 45475-2144
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
30-023424
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0054438
—
OH
Enumeration date
01/26/2016
Last updated
01/26/2016
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