Provider Demographics
NPI:1851799399
Name:DECLERCK FAMILY DENTAL
Entity Type:Organization
Organization Name:DECLERCK FAMILY DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:
Authorized Official - Last Name:PARKINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:419-422-8972
Mailing Address - Street 1:15840 MEDICAL DR S STE C
Mailing Address - Street 2:
Mailing Address - City:FINDLAY
Mailing Address - State:OH
Mailing Address - Zip Code:45840-7833
Mailing Address - Country:US
Mailing Address - Phone:419-422-8972
Mailing Address - Fax:419-422-8973
Practice Address - Street 1:15840 MEDICAL DR S STE C
Practice Address - Street 2:
Practice Address - City:FINDLAY
Practice Address - State:OH
Practice Address - Zip Code:45840-7833
Practice Address - Country:US
Practice Address - Phone:419-422-8972
Practice Address - Fax:419-422-8973
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-16
Last Update Date:2014-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30023435122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty