Provider Demographics
NPI:1619272887
Name:AVERY DENTAL GROUP INC. E. TARTARTA, D.D.S., KATHRYN ELIA-APOTSOS D.D.
Entity Type:Organization
Organization Name:AVERY DENTAL GROUP INC. E. TARTARTA, D.D.S., KATHRYN ELIA-APOTSOS D.D.
Other - Org Name:E. TARTARA D.D.S. INC.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:KATHRYN
Authorized Official - Middle Name:JOANNE
Authorized Official - Last Name:ELIA-APOTSOS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:440-526-4866
Mailing Address - Street 1:8200 AVERY RD
Mailing Address - Street 2:
Mailing Address - City:BROADVIEW HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44147
Mailing Address - Country:US
Mailing Address - Phone:440-526-4866
Mailing Address - Fax:440-526-9298
Practice Address - Street 1:8200 AVERY RD
Practice Address - Street 2:
Practice Address - City:BROADVIEW HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44147
Practice Address - Country:US
Practice Address - Phone:440-526-4866
Practice Address - Fax:440-526-9298
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-20
Last Update Date:2011-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty