Organization
PEDIATRIC DENTISTRY, JOHN A. GENNANTONIO, D.D.S., INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TRACEY GRAF (OFFICE MANAGER)
(513) 474-6777
Entity
Organization
Contact information
Practice address
7801 BEECHMONT AVE, SUITE 5, CINCINNATI, OH 45255-4211
(513) 474-6777
(513) 474-2326
Mailing address
7801 BEECHMONT AVE, SUITE 5, CINCINNATI, OH 45255-4211
(513) 474-6777
(513) 474-2326
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
30019420
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0000896937
UNITED CONCORDIA GROUP ID
OH
05
—
0924807
—
OH
Enumeration date
03/23/2006
Last updated
08/22/2020
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