Provider Demographics
NPI:1407146079
Name:MICHAEL D WASCO DDS LLC
Entity Type:Organization
Organization Name:MICHAEL D WASCO DDS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:D
Authorized Official - Last Name:WASCO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-854-5897
Mailing Address - Street 1:987C CHERRY ST E
Mailing Address - Street 2:P.O BOX 346
Mailing Address - City:CANAL FULTON
Mailing Address - State:OH
Mailing Address - Zip Code:44614-9609
Mailing Address - Country:US
Mailing Address - Phone:330-854-4897
Mailing Address - Fax:
Practice Address - Street 1:987C CHERRY ST E
Practice Address - Street 2:
Practice Address - City:CANAL FULTON
Practice Address - State:OH
Practice Address - Zip Code:44614-9609
Practice Address - Country:US
Practice Address - Phone:330-854-4897
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-15
Last Update Date:2011-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30.0228121223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty