Provider Demographics
NPI:1629381439
Name:LEXINGTON AND MARDJJ INC
Entity Type:Organization
Organization Name:LEXINGTON AND MARDJJ INC
Other - Org Name:MIDWEST DENTAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:GIFT
Authorized Official - Middle Name:
Authorized Official - Last Name:NGO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:419-475-5450
Mailing Address - Street 1:1843 W ALEXIS RD STE 4
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43613-2354
Mailing Address - Country:US
Mailing Address - Phone:419-475-5450
Mailing Address - Fax:
Practice Address - Street 1:1843 W ALEXIS RD STE 4
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43613-2354
Practice Address - Country:US
Practice Address - Phone:419-475-5450
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PARENT ORGANIZATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-07-21
Last Update Date:2010-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH21093122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty