Provider Demographics
NPI:1134294150
Name:LAKEWOOD DENTAL ARTS-EDWARD A HADAWAY DDS& DENVER D JENKINS JR DDS LLC
Entity Type:Organization
Organization Name:LAKEWOOD DENTAL ARTS-EDWARD A HADAWAY DDS& DENVER D JENKINS JR DDS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:A
Authorized Official - Last Name:HADAWAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:216-221-3368
Mailing Address - Street 1:17117 DETROIT AVE
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44107-3622
Mailing Address - Country:US
Mailing Address - Phone:216-221-3368
Mailing Address - Fax:216-221-3371
Practice Address - Street 1:17117 DETROIT AVE
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:OH
Practice Address - Zip Code:44107-3622
Practice Address - Country:US
Practice Address - Phone:216-221-3368
Practice Address - Fax:216-221-3371
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-22
Last Update Date:2008-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty