Provider Demographics
NPI:1851832505
Name:VILLAGE DENTAL ORRVILLE BETTY J QADRI DDS LLC
Entity Type:Organization
Organization Name:VILLAGE DENTAL ORRVILLE BETTY J QADRI DDS LLC
Other - Org Name:VILLAGE DENTAL ORRVILLE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BETTY
Authorized Official - Middle Name:J
Authorized Official - Last Name:QADRI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:330-682-0911
Mailing Address - Street 1:310 MAPLE ST
Mailing Address - Street 2:
Mailing Address - City:ORRVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44667-1456
Mailing Address - Country:US
Mailing Address - Phone:330-682-0911
Mailing Address - Fax:330-682-1811
Practice Address - Street 1:310 MAPLE ST
Practice Address - Street 2:
Practice Address - City:ORRVILLE
Practice Address - State:OH
Practice Address - Zip Code:44667-1456
Practice Address - Country:US
Practice Address - Phone:330-682-0911
Practice Address - Fax:330-682-1811
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:VILLAGE DENTAL BETTY J QADRI DDS INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-03-14
Last Update Date:2017-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH19827122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty