Provider Demographics
NPI:1760601397
Name:CHILDREN'S DENTAL ASSOC., INC.
Entity Type:Organization
Organization Name:CHILDREN'S DENTAL ASSOC., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE-PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:440-708-1331
Mailing Address - Street 1:8401 CHAGRIN RD
Mailing Address - Street 2:# 2
Mailing Address - City:CHAGRIN FALLS
Mailing Address - State:OH
Mailing Address - Zip Code:44023-4701
Mailing Address - Country:US
Mailing Address - Phone:440-708-1331
Mailing Address - Fax:440-708-1777
Practice Address - Street 1:8401 CHAGRIN RD
Practice Address - Street 2:# 2
Practice Address - City:CHAGRIN FALLS
Practice Address - State:OH
Practice Address - Zip Code:44023-4701
Practice Address - Country:US
Practice Address - Phone:440-708-1331
Practice Address - Fax:440-708-1777
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH159031223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty