Provider Demographics
NPI:1538333224
Name:DENTAL SERVICES OF NORTHERN OHIO
Entity Type:Organization
Organization Name:DENTAL SERVICES OF NORTHERN OHIO
Other - Org Name:IMMEDIADENT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CREDENTIALING COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:JADA
Authorized Official - Middle Name:
Authorized Official - Last Name:HUSS
Authorized Official - Suffix:
Authorized Official - Credentials:CPCS
Authorized Official - Phone:816-268-8340
Mailing Address - Street 1:1698 W MARKET ST
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44313-7002
Mailing Address - Country:US
Mailing Address - Phone:330-864-3000
Mailing Address - Fax:330-864-3003
Practice Address - Street 1:1698 W MARKET ST
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44313-7002
Practice Address - Country:US
Practice Address - Phone:330-864-3000
Practice Address - Fax:330-864-3003
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-15
Last Update Date:2008-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty