Provider Demographics
NPI:1407921117
Name:ADA FAMILY DENTISTRY
Entity Type:Organization
Organization Name:ADA FAMILY DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BILLY
Authorized Official - Middle Name:T
Authorized Official - Last Name:MORGAN
Authorized Official - Suffix:III
Authorized Official - Credentials:DDS
Authorized Official - Phone:419-634-1050
Mailing Address - Street 1:4350 ST RT 235
Mailing Address - Street 2:
Mailing Address - City:ADA
Mailing Address - State:OH
Mailing Address - Zip Code:45810
Mailing Address - Country:US
Mailing Address - Phone:419-634-1050
Mailing Address - Fax:419-634-0539
Practice Address - Street 1:4350 SR 235
Practice Address - Street 2:
Practice Address - City:ADA
Practice Address - State:OH
Practice Address - Zip Code:45810
Practice Address - Country:US
Practice Address - Phone:419-634-1050
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty