Provider Demographics
NPI:1437458551
Name:M MARK LEPORE DDS, INC
Entity Type:Organization
Organization Name:M MARK LEPORE DDS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:GENA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:SCHEID
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:440-442-2901
Mailing Address - Street 1:5576 MAYFIELD RD
Mailing Address - Street 2:
Mailing Address - City:LYNDHURST
Mailing Address - State:OH
Mailing Address - Zip Code:44124-2928
Mailing Address - Country:US
Mailing Address - Phone:440-442-2901
Mailing Address - Fax:440-442-1932
Practice Address - Street 1:5576 MAYFIELD RD
Practice Address - Street 2:
Practice Address - City:LYNDHURST
Practice Address - State:OH
Practice Address - Zip Code:44124-2928
Practice Address - Country:US
Practice Address - Phone:440-442-2901
Practice Address - Fax:440-442-1932
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-16
Last Update Date:2011-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30.017191122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2772870Medicaid