Unknown Individual – Orthodontics and Dentofacial Orthopedics Dentistry, NPI 1477562700

Orthodontics and Dentofacial Orthopedics Dentistry

Unknown Individual is a healthcare provider. based in Columbus, Ohio. specializing in Orthodontics and Dentofacial Orthopedics Dentistry. They hold a License No. 4373 (OH). The NPI Number for Unknown Individual is 1477562700

Main info

Organization

Inactive

51 Years Of Experience

Name

Unknown Individual

NPI

1477562700

Phone

(614) 292-1172

Address

305 W 12TH AVE

Deactivation Date

26 October 2022

Doctor Profile

Medical School Name

COLUMBIA UNIVERSITY COLLEGE OF PHYSICIANS AND SURGEONS

Secondary Phone

6142921472

Graduation Year

1975 (51 years ago)

PAC ID

2567514870

Group Practice PAC ID

5496788630

Professional Enrollment ID

I20090717000271

Data current as of

19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology

Experience14

Completeness75

Years active:0State licenses:1Digital endpointsOther names

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Provider Addresses for Unknown Individual

Ohio State Dental Clinics, 305, West Twelfth Avenue, University District District 4, Columbus, Sharon, Franklin, Ohio, 43210, United States
4088D POSTLE HALL COLLEGE OF DENTISTRY
COLUMBUS, OH 432101267
Phone: (614) 292-1172
Type: Location
1012, Woodington Road, Westerville, Sharon, Franklin County, Ohio, 43081, United States
WESTERVILLE, OH 430813517
Phone: (614) 804-9783
Type: Mailing

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

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Open Payments (CMS)

No Open Payments data available for this provider.

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Medicare Enrollment & Revalidation

Source: CMS public data · Not endorsed by CMS ·

Educational use only—not medical, billing, or legal advice.

No Medicare enrollment or revalidation data available for this provider in our database.

Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS

Medicare Utilization (FFS)

Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·

Educational use only—not medical, billing, or legal advice.

No Medicare fee-for-service utilization data available for this provider in our database.

Insurance plans in this area (ZIP 43210)

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Group practice members

Group practice members are other physicians who share the same Group Practice PAC ID with this doctor. When doctors form a group practice and register in PECOS as a single entity, they receive a shared identification number. This table lists all providers in the same group practice.

PAC ID: 5496788630View full group profile

Name	Specialty	State
DR. PETER ERIC LARSEN (DDS)	-	OH
DR. HANY EMAM (BDS)	Oral Surgery, Maxillofacial Surgery	OH
DR. KELLY SUE KENNEDY (D.D.S.)	Oral Surgery, Maxillofacial Surgery	OH
DR. JAMES HARRY COTTLE (D.D.S.)	D E N T I S T	OH
DR. COURTNEY ANN JATANA (D.D.S.)	Maxillofacial Surgery, Oral Surgery	OH

Reviews

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Frequently asked questions

What federal number belongs to Unknown Individual?

The federal identifier for Unknown Individual is NPI 1477562700.

Is Unknown Individual's inactive status permanent?

An inactive NPI does not by itself prove someone stopped practicing — check other sources.

Does Unknown Individual list a primary specialty?

If you are matching referrals, note Orthodontics and Dentofacial Orthopedics Dentistry for Unknown Individual. Clinical services aligned with this taxonomy classification.

Where does public data place Unknown Individual?

The snapshot lists Columbus, Ohio for Unknown Individual; download NPPES for the complete set.

What if Columbus, Ohio seems incomplete?

Street-level detail can be omitted — open the full address list for this NPI.