Provider Demographics
NPI:1548755333
Name:MCDUFFEE LIMA DENTISTRY LLC
Entity Type:Organization
Organization Name:MCDUFFEE LIMA DENTISTRY LLC
Other - Org Name:CENTERBURG DENTAL CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MALINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:SHIPMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:740-480-8162
Mailing Address - Street 1:3927 COLUMBUS RD
Mailing Address - Street 2:
Mailing Address - City:CENTERBURG
Mailing Address - State:OH
Mailing Address - Zip Code:43011-9475
Mailing Address - Country:US
Mailing Address - Phone:740-480-8162
Mailing Address - Fax:740-480-8179
Practice Address - Street 1:3927 COLUMBUS RD
Practice Address - Street 2:
Practice Address - City:CENTERBURG
Practice Address - State:OH
Practice Address - Zip Code:43011-9475
Practice Address - Country:US
Practice Address - Phone:740-480-8162
Practice Address - Fax:740-480-8179
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MCDUFFEE LIMA DENTISTRY LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-06-25
Last Update Date:2018-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH17811261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH=========Other1659331437
OH=========Other1285749465