Provider Demographics
NPI:1053561191
Name:OHIO VALLEY DENTAL
Entity type:Organization
Organization Name:OHIO VALLEY DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ADRIENNE
Authorized Official - Middle Name:ROCHELLE
Authorized Official - Last Name:MINER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:740-695-5535
Mailing Address - Street 1:67800 MALL RING ROAD
Mailing Address - Street 2:C/O SEARS
Mailing Address - City:ST. CLAIRSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43950
Mailing Address - Country:US
Mailing Address - Phone:740-695-5535
Mailing Address - Fax:740-695-5958
Practice Address - Street 1:67800 MALL RING ROAD
Practice Address - Street 2:C/O SEARS
Practice Address - City:ST. CLAIRSVILLE
Practice Address - State:OH
Practice Address - Zip Code:43950
Practice Address - Country:US
Practice Address - Phone:740-695-5535
Practice Address - Fax:740-695-5958
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-25
Last Update Date:2008-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH18079122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty