Provider Demographics
NPI:1851519227
Name:DENTAL HEALTH ASSOCIATES OF STREETSBORO
Entity Type:Organization
Organization Name:DENTAL HEALTH ASSOCIATES OF STREETSBORO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:COHEN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:330-864-9090
Mailing Address - Street 1:9150 MARKET SQUARE DR
Mailing Address - Street 2:SUITE 103
Mailing Address - City:STREETSBORO
Mailing Address - State:OH
Mailing Address - Zip Code:44241-4571
Mailing Address - Country:US
Mailing Address - Phone:330-626-9090
Mailing Address - Fax:330-626-9730
Practice Address - Street 1:9150 MARKET SQUARE DR
Practice Address - Street 2:SUITE 103
Practice Address - City:STREETSBORO
Practice Address - State:OH
Practice Address - Zip Code:44241-4571
Practice Address - Country:US
Practice Address - Phone:330-626-9090
Practice Address - Fax:330-626-9730
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH21397122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty