Provider Demographics
NPI:1205072253
Name:DENTAL EXPRESS, LLC
Entity type:Organization
Organization Name:DENTAL EXPRESS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TED
Authorized Official - Middle Name:A
Authorized Official - Last Name:SCHUSTER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:330-533-8699
Mailing Address - Street 1:3830 STARRS CENTRE DR
Mailing Address - Street 2:SUITE 2
Mailing Address - City:CANFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44406-8003
Mailing Address - Country:US
Mailing Address - Phone:330-533-8699
Mailing Address - Fax:330-533-2501
Practice Address - Street 1:3830 STARRS CENTRE DR
Practice Address - Street 2:SUITE 2
Practice Address - City:CANFIELD
Practice Address - State:OH
Practice Address - Zip Code:44406-8003
Practice Address - Country:US
Practice Address - Phone:330-533-8699
Practice Address - Fax:330-533-2501
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-22
Last Update Date:2008-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH206541223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty