Provider Demographics
NPI:1023259546
Name:NORTHERN DENTAL SPECIALISTS, DR. STEVEN W GAJDA
Entity type:Organization
Organization Name:NORTHERN DENTAL SPECIALISTS, DR. STEVEN W GAJDA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:W
Authorized Official - Last Name:GAJDA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MSD
Authorized Official - Phone:440-428-7290
Mailing Address - Street 1:2040 HUBBARD ROAD
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:OH
Mailing Address - Zip Code:44057
Mailing Address - Country:US
Mailing Address - Phone:440-428-7290
Mailing Address - Fax:440-428-0911
Practice Address - Street 1:2040 HUBBARD ROAD
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:OH
Practice Address - Zip Code:44057
Practice Address - Country:US
Practice Address - Phone:440-428-7290
Practice Address - Fax:440-428-0911
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NORTHERN DENTAL SPECIALISTS, DR. STEVEN W GAJDA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-03-12
Last Update Date:2009-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30-0227161223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty