Provider Demographics
NPI:1447226998
Name:KIDSMILE, INC. - JOHN M. VENZEL, D.M.D.
Entity Type:Organization
Organization Name:KIDSMILE, INC. - JOHN M. VENZEL, D.M.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:MATTHEW
Authorized Official - Last Name:VENZEL
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:440-934-2600
Mailing Address - Street 1:37701 COLORADO AVE
Mailing Address - Street 2:SUITE E
Mailing Address - City:AVON
Mailing Address - State:OH
Mailing Address - Zip Code:44011-2840
Mailing Address - Country:US
Mailing Address - Phone:440-934-2600
Mailing Address - Fax:440-934-2602
Practice Address - Street 1:37701 COLORADO AVE
Practice Address - Street 2:SUITE E
Practice Address - City:AVON
Practice Address - State:OH
Practice Address - Zip Code:44011-2840
Practice Address - Country:US
Practice Address - Phone:440-934-2600
Practice Address - Fax:440-934-2602
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30.0179511223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0603716Medicaid
OH774120OtherUNITED CONCORDIA PROVIDER
OH603882OtherCOMPBENEFITS PROVIDER ID