Provider Demographics
NPI:1174503056
Name:TWINSBURG DENTAL ASSOCIATES
Entity Type:Organization
Organization Name:TWINSBURG DENTAL ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:330-425-0912
Mailing Address - Street 1:9945 VAIL DRIVE
Mailing Address - Street 2:SUITE #1
Mailing Address - City:TWINSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:44087
Mailing Address - Country:US
Mailing Address - Phone:330-425-0912
Mailing Address - Fax:330-425-3854
Practice Address - Street 1:9945 VAIL DRIVE
Practice Address - Street 2:SUITE #1
Practice Address - City:TWINSBURG
Practice Address - State:OH
Practice Address - Zip Code:44087
Practice Address - Country:US
Practice Address - Phone:330-425-0912
Practice Address - Fax:330-425-3854
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30016458122300000X
OH30016426122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty