Provider Demographics
NPI:1073525689
Name:MAHONING VALLEY DENTAL SERVICES
Entity Type:Organization
Organization Name:MAHONING VALLEY DENTAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:LISA
Authorized Official - Middle Name:A
Authorized Official - Last Name:MORELLA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-759-1771
Mailing Address - Street 1:5100 BELMONT AVE
Mailing Address - Street 2:SUITE 1
Mailing Address - City:YOUNGSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44505-1043
Mailing Address - Country:US
Mailing Address - Phone:330-759-1711
Mailing Address - Fax:330-759-1227
Practice Address - Street 1:5100 BELMONT AVE
Practice Address - Street 2:SUITE 1
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44505-1043
Practice Address - Country:US
Practice Address - Phone:330-759-1771
Practice Address - Fax:330-759-1227
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty