Provider Demographics
NPI:1861852279
Name:COMPLETE DENTAL CARE OF MARTINS FERRY
Entity Type:Organization
Organization Name:COMPLETE DENTAL CARE OF MARTINS FERRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ARMANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:LESTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:740-485-0309
Mailing Address - Street 1:317 N ZANE HWY
Mailing Address - Street 2:
Mailing Address - City:MARTINS FERRY
Mailing Address - State:OH
Mailing Address - Zip Code:43935-1624
Mailing Address - Country:US
Mailing Address - Phone:740-633-1800
Mailing Address - Fax:740-609-3287
Practice Address - Street 1:317 N ZANE HWY
Practice Address - Street 2:
Practice Address - City:MARTINS FERRY
Practice Address - State:OH
Practice Address - Zip Code:43935-1624
Practice Address - Country:US
Practice Address - Phone:740-633-1800
Practice Address - Fax:740-609-3287
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-26
Last Update Date:2016-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0060692Medicaid
OH0137754Medicaid
OH0138111Medicaid