Provider Demographics
NPI:1629615794
Name:LIMAZWICK-URBANA LLC
Entity Type:Organization
Organization Name:LIMAZWICK-URBANA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:MASON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:937-653-8650
Mailing Address - Street 1:139 PATRICK AVE
Mailing Address - Street 2:
Mailing Address - City:URBANA
Mailing Address - State:OH
Mailing Address - Zip Code:43078-2123
Mailing Address - Country:US
Mailing Address - Phone:937-653-8650
Mailing Address - Fax:937-653-8606
Practice Address - Street 1:139 PATRICK AVE
Practice Address - Street 2:
Practice Address - City:URBANA
Practice Address - State:OH
Practice Address - Zip Code:43078-2123
Practice Address - Country:US
Practice Address - Phone:937-653-8650
Practice Address - Fax:937-653-8606
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-07
Last Update Date:2019-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty