Provider Demographics
NPI:1790803195
Name:VILLAGE DENTAL INC
Entity Type:Organization
Organization Name:VILLAGE DENTAL INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BETTY
Authorized Official - Middle Name:JANE
Authorized Official - Last Name:QADRI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:330-655-2916
Mailing Address - Street 1:41 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HUDSON
Mailing Address - State:OH
Mailing Address - Zip Code:44236
Mailing Address - Country:US
Mailing Address - Phone:330-655-2916
Mailing Address - Fax:330-650-9846
Practice Address - Street 1:41 E MAIN ST
Practice Address - Street 2:
Practice Address - City:HUDSON
Practice Address - State:OH
Practice Address - Zip Code:44236
Practice Address - Country:US
Practice Address - Phone:330-655-2916
Practice Address - Fax:330-650-9846
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-26
Last Update Date:2017-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH198271223G0001X
OH198741223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty