Organization
PRIMEHEALTH OF OHIO LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
PAMELA B DEVAULT (DELEGATED OFFICIAL)
(224) 632-5613
Entity
Organization
Contact information
Practice address
20 S 3RD ST STE 210, COLUMBUS, OH 43215-4206
(844) 882-3127
Mailing address
2100 E LAKE COOK RD STE 1000, BUFFALO GROVE, IL 60089-1999
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0180374
—
OH
Enumeration date
08/31/2018
Last updated
08/31/2018
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