Provider Demographics
NPI:1417128497
Name:O.W.A. MANAGEMENT SERVICES, LLC
Entity Type:Organization
Organization Name:O.W.A. MANAGEMENT SERVICES, LLC
Other - Org Name:CLEVELAND FAMILY DENTAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:LYDIA
Authorized Official - Middle Name:D
Authorized Official - Last Name:TURNER
Authorized Official - Suffix:
Authorized Official - Credentials:RDH
Authorized Official - Phone:706-219-0033
Mailing Address - Street 1:3777 HIGHWAY 129 S
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:GA
Mailing Address - Zip Code:30528-5823
Mailing Address - Country:US
Mailing Address - Phone:706-219-0033
Mailing Address - Fax:
Practice Address - Street 1:3777 HIGHWAY 129 SOUTH
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:GA
Practice Address - Zip Code:30528-5823
Practice Address - Country:US
Practice Address - Phone:706-219-0033
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-18
Last Update Date:2008-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty