Provider Demographics
NPI:1205853488
Name:STOW DENTAL GROUP, INC.
Entity Type:Organization
Organization Name:STOW DENTAL GROUP, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:A
Authorized Official - Last Name:IATI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:330-688-6456
Mailing Address - Street 1:3506 DARROW RD
Mailing Address - Street 2:
Mailing Address - City:STOW
Mailing Address - State:OH
Mailing Address - Zip Code:44224-4009
Mailing Address - Country:US
Mailing Address - Phone:330-688-6456
Mailing Address - Fax:330-688-4178
Practice Address - Street 1:3506 DARROW RD
Practice Address - Street 2:
Practice Address - City:STOW
Practice Address - State:OH
Practice Address - Zip Code:44224-4009
Practice Address - Country:US
Practice Address - Phone:330-688-6456
Practice Address - Fax:330-688-4178
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH=========OtherTIN