Provider Demographics
NPI:1356498844
Name:PERIODONTAL ASSOCIATES, INC.
Entity Type:Organization
Organization Name:PERIODONTAL ASSOCIATES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROGER
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:HESS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:440-461-3400
Mailing Address - Street 1:29001 CEDAR RD
Mailing Address - Street 2:SUITE 450
Mailing Address - City:LYNDHURST
Mailing Address - State:OH
Mailing Address - Zip Code:44124-4062
Mailing Address - Country:US
Mailing Address - Phone:440-461-3400
Mailing Address - Fax:440-461-1722
Practice Address - Street 1:29001 CEDAR RD
Practice Address - Street 2:SUITE 450
Practice Address - City:LYNDHURST
Practice Address - State:OH
Practice Address - Zip Code:44124-4062
Practice Address - Country:US
Practice Address - Phone:440-461-3400
Practice Address - Fax:440-461-1722
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH182321223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Single Specialty