Provider Demographics
NPI:1609866227
Name:LOCUST DENTAL CENTER
Entity Type:Organization
Organization Name:LOCUST DENTAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:GAIL
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:KAMLOWSKY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-535-7876
Mailing Address - Street 1:300 LOCUST ST
Mailing Address - Street 2:SUITE 430
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44302-1821
Mailing Address - Country:US
Mailing Address - Phone:330-535-7876
Mailing Address - Fax:330-535-9490
Practice Address - Street 1:300 LOCUST ST
Practice Address - Street 2:SUITE 430
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44302-1821
Practice Address - Country:US
Practice Address - Phone:330-535-7876
Practice Address - Fax:330-535-9490
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-25
Last Update Date:2013-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0262933Medicaid