Provider Demographics
NPI:1356647374
Name:ADVANCED DENTAL CARE
Entity Type:Organization
Organization Name:ADVANCED DENTAL CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NEDA
Authorized Official - Middle Name:
Authorized Official - Last Name:YAZDANI
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:419-675-2210
Mailing Address - Street 1:965 E COLUMBUS ST
Mailing Address - Street 2:
Mailing Address - City:KENTON
Mailing Address - State:OH
Mailing Address - Zip Code:43326-1650
Mailing Address - Country:US
Mailing Address - Phone:419-675-2210
Mailing Address - Fax:419-675-2216
Practice Address - Street 1:965 E COLUMBUS ST
Practice Address - Street 2:
Practice Address - City:KENTON
Practice Address - State:OH
Practice Address - Zip Code:43326-1650
Practice Address - Country:US
Practice Address - Phone:419-675-2210
Practice Address - Fax:419-675-2216
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-09
Last Update Date:2011-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty