Provider Demographics
NPI:1578970166
Name:OAK HARBOR DENTAL, MARK R. BEDFORD DDS INC.
Entity Type:Organization
Organization Name:OAK HARBOR DENTAL, MARK R. BEDFORD DDS INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:R
Authorized Official - Last Name:BEDFORD
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:440-292-5773
Mailing Address - Street 1:11707 W STATE ROUTE 163
Mailing Address - Street 2:
Mailing Address - City:OAK HARBOR
Mailing Address - State:OH
Mailing Address - Zip Code:43449-9401
Mailing Address - Country:US
Mailing Address - Phone:419-898-6633
Mailing Address - Fax:419-898-9909
Practice Address - Street 1:11707 W STATE ROUTE 163
Practice Address - Street 2:
Practice Address - City:OAK HARBOR
Practice Address - State:OH
Practice Address - Zip Code:43449-9401
Practice Address - Country:US
Practice Address - Phone:419-898-6633
Practice Address - Fax:419-898-9909
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-16
Last Update Date:2014-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH159021223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty