| SC | |
|
107 W Columbus St Pickerington OH 43147-1257 | |
| (614) 829-7703 | |
| (614) 829-7811 |
| Full Name | SC |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 107 W Columbus St, Pickerington, Ohio |
| Authorized Official Name and Position | Angel Renee Bradshaw (DIRECTOR OF OPERATIONS) |
| Authorized Official Contact | 3304690487 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| SC 107 W Columbus St Pickerington OH 43147 Ph: (614) 829-7703 | SC 107 W Columbus St Pickerington OH 43147-1257 Ph: (614) 829-7703 |
| NPI Number | 1275030686 |
|---|---|
| Provider Enumeration Date | 04/11/2018 |
| Last Update Date | 04/11/2018 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1275030686 | NPI | - | NPPES |
| 0095268 | Medicaid | OH |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | 30.022821 (Ohio) | Primary |
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