Provider Demographics
NPI:1568083392
Name:WILLIAM L MEDVED DDS FAMILY DENTISTRY,INC
Entity Type:Organization
Organization Name:WILLIAM L MEDVED DDS FAMILY DENTISTRY,INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FRONT DESK
Authorized Official - Prefix:
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:L
Authorized Official - Last Name:GLENN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:740-653-9660
Mailing Address - Street 1:330 N BROAD ST
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:OH
Mailing Address - Zip Code:43130-3003
Mailing Address - Country:US
Mailing Address - Phone:740-653-9660
Mailing Address - Fax:740-653-8975
Practice Address - Street 1:330 N BROAD ST
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:OH
Practice Address - Zip Code:43130-3003
Practice Address - Country:US
Practice Address - Phone:740-653-9660
Practice Address - Fax:740-653-8975
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-04
Last Update Date:2020-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental