Provider Demographics
NPI:1639214745
Name:AKRON SMILES YOUTH DENTISTRY LLC MICHAEL CRITES, DDS
Entity Type:Organization
Organization Name:AKRON SMILES YOUTH DENTISTRY LLC MICHAEL CRITES, DDS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER, L&C
Authorized Official - Prefix:MS
Authorized Official - First Name:JENELL
Authorized Official - Middle Name:
Authorized Official - Last Name:STUMP
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-750-0343
Mailing Address - Street 1:16 ARCADE UNIT 198747
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37219-1994
Mailing Address - Country:US
Mailing Address - Phone:615-750-0343
Mailing Address - Fax:615-986-1705
Practice Address - Street 1:881 E EXCHANGE ST
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44306-1127
Practice Address - Country:US
Practice Address - Phone:330-208-1100
Practice Address - Fax:330-208-1101
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-20
Last Update Date:2014-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2712443Medicaid
OH002127932OtherUNITED CONCORDIA
OH179751OtherDENTAQUEST
OH=========026OtherCARESOURCE