Provider Demographics
NPI:1558860130
Name:ALAN B SCHLESINGER DDS LLC
Entity Type:Organization
Organization Name:ALAN B SCHLESINGER DDS LLC
Other - Org Name:WARREN DENTAL GROUP ALAN B SCHLESINGER DDS LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:
Authorized Official - Last Name:WILK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-395-3820
Mailing Address - Street 1:1019 N PARK AVE
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:OH
Mailing Address - Zip Code:44483-3725
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1019 N PARK AVE
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:OH
Practice Address - Zip Code:44483-3725
Practice Address - Country:US
Practice Address - Phone:330-395-3820
Practice Address - Fax:330-392-7406
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ALAN B SCHLESINGER DDS LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-02-08
Last Update Date:2018-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30.20746122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0143560Medicaid
OH0520341Medicaid
OH0055702Medicaid