Provider Demographics
NPI:1790830743
Name:SPRING VALLEY DENTAL INC.
Entity Type:Organization
Organization Name:SPRING VALLEY DENTAL INC.
Other - Org Name:SAM OH DMD
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SAM
Authorized Official - Middle Name:
Authorized Official - Last Name:OH
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:419-865-4441
Mailing Address - Street 1:1359 S HOLLAND SYLVANIA RD
Mailing Address - Street 2:
Mailing Address - City:HOLLAND
Mailing Address - State:OH
Mailing Address - Zip Code:43528-8423
Mailing Address - Country:US
Mailing Address - Phone:419-865-4441
Mailing Address - Fax:419-865-9032
Practice Address - Street 1:1359 S HOLLAND SYLVANIA RD
Practice Address - Street 2:
Practice Address - City:HOLLAND
Practice Address - State:OH
Practice Address - Zip Code:43528-8423
Practice Address - Country:US
Practice Address - Phone:419-865-4441
Practice Address - Fax:419-865-9032
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH21182122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty