Provider Demographics
NPI:1881867778
Name:CHILDREN'S SMILES DENTAL CARE, INC.
Entity Type:Organization
Organization Name:CHILDREN'S SMILES DENTAL CARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PEDIATRIC DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:TYRA
Authorized Official - Middle Name:L
Authorized Official - Last Name:MEYER
Authorized Official - Suffix:
Authorized Official - Credentials:DDSMS
Authorized Official - Phone:419-229-3007
Mailing Address - Street 1:2969 BLUE JACKET CT
Mailing Address - Street 2:
Mailing Address - City:LIMA
Mailing Address - State:OH
Mailing Address - Zip Code:45806-1464
Mailing Address - Country:US
Mailing Address - Phone:419-229-3007
Mailing Address - Fax:419-229-0214
Practice Address - Street 1:2969 BLUE JACKET CT.
Practice Address - Street 2:
Practice Address - City:LIMA
Practice Address - State:OH
Practice Address - Zip Code:45806-1464
Practice Address - Country:US
Practice Address - Phone:419-229-3007
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-11
Last Update Date:2008-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH300203251223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2354429Medicaid