Provider Demographics
NPI:1972744191
Name:AVON FAMILY DENTISTRY
Entity Type:Organization
Organization Name:AVON FAMILY DENTISTRY
Other - Org Name:BUCKEYE DENTAL AND BRACES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:GEOFFREY
Authorized Official - Middle Name:LOUIS
Authorized Official - Last Name:STEFKO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:888-276-4530
Mailing Address - Street 1:P.O. BOX 429
Mailing Address - Street 2:
Mailing Address - City:AVON
Mailing Address - State:OH
Mailing Address - Zip Code:44011
Mailing Address - Country:US
Mailing Address - Phone:888-276-4530
Mailing Address - Fax:330-483-6141
Practice Address - Street 1:36900 DETROIT ROAD
Practice Address - Street 2:
Practice Address - City:AVON
Practice Address - State:OH
Practice Address - Zip Code:44011
Practice Address - Country:US
Practice Address - Phone:888-276-4530
Practice Address - Fax:330-483-6141
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-18
Last Update Date:2009-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty