| Klermont 4 Kids & Adults 2 | |
|
497 W Main St Batavia OH 45103-1727 | |
| (513) 735-9111 | |
| (513) 735-9222 |
| Full Name | Klermont 4 Kids & Adults 2 |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 497 W Main St, Batavia, Ohio |
| Authorized Official Name and Position | William Rudolph Fry (BUSINESS MANAGER) |
| Authorized Official Contact | 5137359111 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Klermont 4 Kids & Adults 2 497 W Main St Batavia OH 45103-1727 Ph: (513) 735-9111 | Klermont 4 Kids & Adults 2 497 W Main St Batavia OH 45103-1727 Ph: (513) 735-9111 |
| NPI Number | 1578689295 |
|---|---|
| Provider Enumeration Date | 03/22/2007 |
| Last Update Date | 03/25/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1578689295 | NPI | - | NPPES |
| 470902004028 | Other | OH | HASSAN CARESOURCE |
| 160729464 | Other | OH | DR. HASSAN TID |
| 2231516 | Medicaid | OH | |
| 2362116 | Medicaid | OH | |
| 2431158 | Medicaid | OH | |
| 470902004 | Other | OH | DOELKER TID |
| 470902004029 | Other | OH | CARESOURCE |
| 0263610 | Medicaid | OH |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | 30013796 (Ohio) | Primary |
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