Provider Demographics
NPI:1033289905
Name:AMERICAN DENTAL CENTERS
Entity Type:Organization
Organization Name:AMERICAN DENTAL CENTERS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DDS
Authorized Official - Prefix:DR
Authorized Official - First Name:SAM
Authorized Official - Middle Name:
Authorized Official - Last Name:JAFFE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:440-446-1555
Mailing Address - Street 1:AMERICAN DENTAL CENTERS
Mailing Address - Street 2:6140 PARKLAND BLVD 100
Mailing Address - City:MAYFIELD HTS
Mailing Address - State:OH
Mailing Address - Zip Code:44124
Mailing Address - Country:US
Mailing Address - Phone:440-446-1555
Mailing Address - Fax:440-446-1990
Practice Address - Street 1:AMERICAN DENTAL CENTERS
Practice Address - Street 2:6140 PARKLAND BLVD 100
Practice Address - City:MAYFIELD HTS
Practice Address - State:OH
Practice Address - Zip Code:44124
Practice Address - Country:US
Practice Address - Phone:440-446-1555
Practice Address - Fax:440-446-1990
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty