Provider Demographics
NPI:1952483711
Name:MEDINA ENDODONTIC ASSOCIATES, INC.
Entity Type:Organization
Organization Name:MEDINA ENDODONTIC ASSOCIATES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAWN
Authorized Official - Middle Name:M
Authorized Official - Last Name:ONDRIK
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MSD
Authorized Official - Phone:330-722-3636
Mailing Address - Street 1:3637 MEDINA RD STE 215
Mailing Address - Street 2:
Mailing Address - City:MEDINA
Mailing Address - State:OH
Mailing Address - Zip Code:44256-8154
Mailing Address - Country:US
Mailing Address - Phone:330-722-3636
Mailing Address - Fax:330-722-4171
Practice Address - Street 1:3637 MEDINA RD STE 215
Practice Address - Street 2:
Practice Address - City:MEDINA
Practice Address - State:OH
Practice Address - Zip Code:44256-8154
Practice Address - Country:US
Practice Address - Phone:330-722-3636
Practice Address - Fax:330-722-4171
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH=========OtherTAX ID NUMBER