Provider Demographics
NPI:1578008413
Name:VILLAGE DENTAL HINCKLEY,BETTY J. QADRI, D.D.S. INC.
Entity Type:Organization
Organization Name:VILLAGE DENTAL HINCKLEY,BETTY J. QADRI, D.D.S. INC.
Other - Org Name:VILLAGE DENTAL HINCKLEY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BETTY
Authorized Official - Middle Name:J
Authorized Official - Last Name:QADRI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:330-278-2829
Mailing Address - Street 1:1369 RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:HINCKLEY
Mailing Address - State:OH
Mailing Address - Zip Code:44233-9257
Mailing Address - Country:US
Mailing Address - Phone:330-278-2829
Mailing Address - Fax:330-278-2832
Practice Address - Street 1:1369 RIDGE RD
Practice Address - Street 2:
Practice Address - City:HINCKLEY
Practice Address - State:OH
Practice Address - Zip Code:44233-9257
Practice Address - Country:US
Practice Address - Phone:330-278-2829
Practice Address - Fax:330-278-2832
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-02
Last Update Date:2017-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH19874305S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHCS1502100150Medicare Oscar/Certification