Provider Demographics
NPI:1275714651
Name:MDC OF OHIO
Entity Type:Organization
Organization Name:MDC OF OHIO
Other - Org Name:SPRING VALLEY DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:BEDFORD
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:419-865-4441
Mailing Address - Street 1:1359 S HOLLAND SYLVANIA RD
Mailing Address - Street 2:
Mailing Address - City:HOLLAND
Mailing Address - State:OH
Mailing Address - Zip Code:43528-8423
Mailing Address - Country:US
Mailing Address - Phone:419-865-4441
Mailing Address - Fax:419-865-9032
Practice Address - Street 1:1359 S HOLLAND SYLVANIA RD
Practice Address - Street 2:
Practice Address - City:HOLLAND
Practice Address - State:OH
Practice Address - Zip Code:43528-8423
Practice Address - Country:US
Practice Address - Phone:419-865-4441
Practice Address - Fax:419-865-9032
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MDC OF OHIO
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-11-14
Last Update Date:2008-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH159021223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty