SOUTHERN OHIO ENDODONTICS CLINIC, LLC (NPI# 1619091568) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1619091568 |
| Entity Type | Organization |
| Organization Name | SOUTHERN OHIO ENDODONTICS CLINIC, LLC |
| Practice Address |
31 N Plaza Blvd Chillicothe OH 45601-1759 |
| Practice Telephone | 7407746230 |
| Practice Fax Number | 7407746326 |
| Mailing Telephone | 7407746230 |
| Mailing Fax Number | 7407746326 |
| Enumeration Date | 2007-03-18 |
| Last Update Date | 2020-08-22 |
| Authorized Official Name | DERON REISMAN (PRESIDENT) |
| Authorized Official Telephone | 7407746230 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 1223E0200X |
Dentist Specialization: Endodontics |
20157 | OH | Dental Providers |
| Street Address |
31 N PLAZA BLVD |
| City | CHILLICOTHE |
| State | OH |
| Zip Code | 45601-1759 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1205950748 | Deron Joseph Reisman | Dentist | 31 N Plaza Blvd, Chillicothe, OH 45601-1759 | 2007-03-19 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1407457872 | Mariah Osborne | Social Worker | 4449 Oh-159, Chillicothe, OH 45601 | 2020-11-03 |
| 1831799741 | Cheyianna Hammond | Pharmacist | 85 River Trace, Chillicothe, OH 45601 | 2020-10-29 |
| 1326653932 | Tabitha Shoemaker | Social Worker | 18-20 E 2nd Street, Chillicothe, OH 45601 | 2020-09-10 |
| 1710596937 | Carly Rainey | Pharmacist | 17273 Sr-104, Chillicothe, OH 45601 | 2020-07-23 |
| 1821639386 | Samuel Ethan Henry | Physician Assistant | 17273 Oh 104, Chillicothe, OH 45601 | 2019-10-04 |
| 1881255040 | Brian Andrew Ice | Nurse Practitioner | 4437 Sr 159, Pavillion Ste 125, Chillicothe, OH 45601 | 2019-06-27 |
| 1770053332 | Dwayne Allan Webb | Home Health Aide | 16 N High St, Chillicothe, OH 45601 | 2018-11-27 |
| 1588148902 | Kristine Ann Oberlin | Social Worker | 16149 Oh-104, Chillicothe, OH 45601 | 2018-09-21 |
| 1730674904 | Christopher Lee Davis | Case Manager/Care Coordinator | 312 East 2nd Street, Chillicothe, OH 45601 | 2018-06-28 |
| 1942794201 | Nettie Vanhoy | Counselor | 220 North Plaza Boulavard, Chillicothe, OH 45601 | 2018-06-20 |
| Find all providers in zip 45601 | ||||
| Taxonomy Code | 1223E0200X |
| Grouping | Dental Providers |
| Classification | Dentist |
| Specialization | Endodontics |
| The branch of dentistry that is concerned with the morphology, physiology and pathology of the human dental pulp and periradicular tissues. Its study and practice encompass the basic and clinical sciences including biology of the normal pulp, the etiology, diagnosis, prevention and treatment of diseases and injuries of the pulp and associated periradicular conditions. |
| Notes: Source: Council on Dental Education and Licensure, American Dental Association |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1801945050 | Kerry D Moore | Dentist | 31 North Plaza Blvd, Chillicothe, OH 45601 | 2007-01-09 |
| 1205950748 | Deron Joseph Reisman | Dentist | 31 N Plaza Blvd, Chillicothe, OH 45601-1759 | 2007-03-19 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1831745868 | Iman Attar | Dentist | 2828 Euclid Ave Apt 207, Cleveland, OH 44115-2470 | 2019-08-15 |
| 1609421684 | Columbus Endodontic Specialists | Dentist | 7334 E Broad St Ste C, Blacklick, OH 43004-9239 | 2019-08-06 |
| 1336619873 | Alvaro Rodriguez | Dentist | 26200 George Zeiger Dr Apt 303, Beachwood, OH 44122-7533 | 2018-11-27 |
| 1942725551 | Meckler Dental Providers, Inc. | Dentist | 3455 Center Rd, Brunswick, OH 44212-3688 | 2017-08-04 |
| 1023532421 | Ddc Endodontics LLC | Dentist | 23250 Mercantile Rd Ste 110, Beachwood, OH 44122-5928 | 2017-07-28 |
| 1912428228 | Ghaeth H Yassen | Dentist | 2124 Cornell Drive, Cwru School of Dental Medicine, Cleveland, OH 44106 | 2017-06-28 |
| 1518401108 | Lev, Berberich, Stabile, Direnzo Ltd | Dentist | 8740 E Market St, Warren, OH 44484-2324 | 2016-12-15 |
| 1003359258 | Paul F Siegel Dds Inc | Dentist | 9403 Kenwood Rd Ste B205, Blue Ash, OH 45242-6829 | 2016-11-21 |
| 1346796869 | Professional Dental Alliance Specialty, LLC | Dentist | 7131 Spring Meadows Dr W, Suite C, Holland, OH 43528-7939 | 2016-08-26 |
| 1669847463 | Magdy Beshay | Dentist | 1129 E Aurora Rd Ste 102, Macedonia, OH 44056-1988 | 2015-12-04 |
| Find all providers with the same taxonomy | ||||
| City | CHILLICOTHE |
| Zip Code | 45601 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.