Provider Demographics
NPI:1659608164
Name:DENTAL EXPRESS SHAKER SQUARE TED A SCHUSTER DDS LLC
Entity Type:Organization
Organization Name:DENTAL EXPRESS SHAKER SQUARE TED A SCHUSTER DDS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JANET
Authorized Official - Middle Name:
Authorized Official - Last Name:SODA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-533-3400
Mailing Address - Street 1:3830 STARRS CENTRE DR
Mailing Address - Street 2:
Mailing Address - City:CANFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44406-8003
Mailing Address - Country:US
Mailing Address - Phone:330-533-3400
Mailing Address - Fax:
Practice Address - Street 1:12808 DREXMORE RD
Practice Address - Street 2:
Practice Address - City:SHAKER HTS
Practice Address - State:OH
Practice Address - Zip Code:44120-5609
Practice Address - Country:US
Practice Address - Phone:216-921-8888
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-05
Last Update Date:2010-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3022844122300000X
OH13290122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty