Provider Demographics
NPI:1437321056
Name:UNVERFERTH FAMILY DENTISTRY, INC.
Entity Type:Organization
Organization Name:UNVERFERTH FAMILY DENTISTRY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ERICA
Authorized Official - Middle Name:A
Authorized Official - Last Name:UNVERFERTH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:419-238-4385
Mailing Address - Street 1:707 FOX RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:VAN WERT
Mailing Address - State:OH
Mailing Address - Zip Code:45891-2451
Mailing Address - Country:US
Mailing Address - Phone:419-238-4385
Mailing Address - Fax:419-238-9228
Practice Address - Street 1:707 FOX RD
Practice Address - Street 2:SUITE 200
Practice Address - City:VAN WERT
Practice Address - State:OH
Practice Address - Zip Code:45891-2451
Practice Address - Country:US
Practice Address - Phone:419-238-4385
Practice Address - Fax:419-238-9228
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-25
Last Update Date:2018-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH300244881223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH027886Medicaid
OH0148229Medicaid