Provider Demographics
NPI:1114146826
Name:AFFILIATED FAMILY DENTISTRY MARC B.PRICE,D.D.S. INC.
Entity Type:Organization
Organization Name:AFFILIATED FAMILY DENTISTRY MARC B.PRICE,D.D.S. INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARC
Authorized Official - Middle Name:B
Authorized Official - Last Name:PRICE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:440-954-9544
Mailing Address - Street 1:4212 STATE ROUTE 306
Mailing Address - Street 2:SUITE #300
Mailing Address - City:WILLOUGHBY
Mailing Address - State:OH
Mailing Address - Zip Code:44094-9258
Mailing Address - Country:US
Mailing Address - Phone:440-954-9544
Mailing Address - Fax:440-954-9539
Practice Address - Street 1:4212 STATE ROUTE 306
Practice Address - Street 2:SUITE #300
Practice Address - City:WILLOUGHBY
Practice Address - State:OH
Practice Address - Zip Code:44094-9258
Practice Address - Country:US
Practice Address - Phone:440-954-9544
Practice Address - Fax:440-954-9539
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty