Provider Demographics
NPI:1164570255
Name:OHIO ORTHODONTIC SPECIALISTS
Entity Type:Organization
Organization Name:OHIO ORTHODONTIC SPECIALISTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORTHODONTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DALE
Authorized Official - Middle Name:A
Authorized Official - Last Name:KATES
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:330-836-0135
Mailing Address - Street 1:2890 SAND RUN PKWY
Mailing Address - Street 2:SUITE A
Mailing Address - City:FAIRLAWN
Mailing Address - State:OH
Mailing Address - Zip Code:44333-2875
Mailing Address - Country:US
Mailing Address - Phone:330-836-0135
Mailing Address - Fax:330-836-3813
Practice Address - Street 1:2890 SAND RUN PKWY
Practice Address - Street 2:SUITE A
Practice Address - City:FAIRLAWN
Practice Address - State:OH
Practice Address - Zip Code:44333-2875
Practice Address - Country:US
Practice Address - Phone:330-836-0135
Practice Address - Fax:330-836-3813
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH198301223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty