Provider Demographics
NPI:1437521317
Name:DENTAL CENTER OF NORTHWEST OHIO
Entity Type:Organization
Organization Name:DENTAL CENTER OF NORTHWEST OHIO
Other - Org Name:VAN WERT SMILES
Other - Org Type:Other Name
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:MELINDA S. CREE
Authorized Official - Middle Name:S
Authorized Official - Last Name:CREE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:419-261-1644
Mailing Address - Street 1:2138 MADISON AVE
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43604-5131
Mailing Address - Country:US
Mailing Address - Phone:419-241-1644
Mailing Address - Fax:419-776-1031
Practice Address - Street 1:140 FOX RD
Practice Address - Street 2:SUITE 207
Practice Address - City:VAN WERT
Practice Address - State:OH
Practice Address - Zip Code:45891-2475
Practice Address - Country:US
Practice Address - Phone:419-241-1644
Practice Address - Fax:419-776-1031
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DENTAL CENTER OF NORTHWEST OHIO
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-10-30
Last Update Date:2015-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental