Provider Demographics
NPI:1013375641
Name:DENTAL HEALTH ASSOCIATES OF SYLVANIA, LTD
Entity type:Organization
Organization Name:DENTAL HEALTH ASSOCIATES OF SYLVANIA, LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INSURANCE COORDINATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:KATHY
Authorized Official - Middle Name:LYNNE
Authorized Official - Last Name:GIBSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:419-882-4510
Mailing Address - Street 1:3924 SYLVAN LAKES BLVD
Mailing Address - Street 2:
Mailing Address - City:SYLVANIA
Mailing Address - State:OH
Mailing Address - Zip Code:43560-8701
Mailing Address - Country:US
Mailing Address - Phone:419-882-4510
Mailing Address - Fax:419-885-3771
Practice Address - Street 1:3924 SYLVAN LAKES BLVD
Practice Address - Street 2:
Practice Address - City:SYLVANIA
Practice Address - State:OH
Practice Address - Zip Code:43560-8701
Practice Address - Country:US
Practice Address - Phone:419-882-4510
Practice Address - Fax:419-885-3771
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-10
Last Update Date:2016-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH166711223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty