Provider Demographics
NPI:1568556595
Name:DRS. HERINGHAUS GENERAL DENITISTRY
Entity Type:Organization
Organization Name:DRS. HERINGHAUS GENERAL DENITISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TERESA
Authorized Official - Middle Name:L
Authorized Official - Last Name:INGEBRAND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:419-524-7409
Mailing Address - Street 1:480 GLESSNER AVE
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44903-2056
Mailing Address - Country:US
Mailing Address - Phone:419-524-7409
Mailing Address - Fax:
Practice Address - Street 1:480 GLESSNER AVE
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:OH
Practice Address - Zip Code:44903-2056
Practice Address - Country:US
Practice Address - Phone:419-524-7409
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH185121223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH3870413Medicaid