Provider Demographics
NPI:1104020171
Name:DENTAL MANAGEMENT SYSTEMS
Entity Type:Organization
Organization Name:DENTAL MANAGEMENT SYSTEMS
Other - Org Name:COBBLESTONE DENTAL ARTS
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:D
Authorized Official - Last Name:JORDAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-336-2542
Mailing Address - Street 1:176 AKRON RD
Mailing Address - Street 2:
Mailing Address - City:WADSWORTH
Mailing Address - State:OH
Mailing Address - Zip Code:44281-1918
Mailing Address - Country:US
Mailing Address - Phone:330-336-2542
Mailing Address - Fax:888-803-7803
Practice Address - Street 1:39037 CENTER RIDGE RD
Practice Address - Street 2:
Practice Address - City:NORTH RIDGEVILLE
Practice Address - State:OH
Practice Address - Zip Code:44039-2741
Practice Address - Country:US
Practice Address - Phone:440-327-1021
Practice Address - Fax:440-327-1171
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30-7122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH=========OtherTAX ID NUMBER