Provider Demographics
NPI:1497147219
Name:GREAT LAKE DENTAL ARTS
Entity Type:Organization
Organization Name:GREAT LAKE DENTAL ARTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:BEECH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:440-255-3111
Mailing Address - Street 1:8435 STATION ST
Mailing Address - Street 2:
Mailing Address - City:MENTOR
Mailing Address - State:OH
Mailing Address - Zip Code:44060-4924
Mailing Address - Country:US
Mailing Address - Phone:440-255-3111
Mailing Address - Fax:440-255-8275
Practice Address - Street 1:8435 STATION ST
Practice Address - Street 2:
Practice Address - City:MENTOR
Practice Address - State:OH
Practice Address - Zip Code:44060-4924
Practice Address - Country:US
Practice Address - Phone:440-255-3111
Practice Address - Fax:440-255-8275
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-03
Last Update Date:2015-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty