Provider Demographics
NPI:1245509330
Name:PENTURF DENTISTRY, LLC
Entity type:Organization
Organization Name:PENTURF DENTISTRY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:BARRY
Authorized Official - Middle Name:
Authorized Official - Last Name:PENTURF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-821-7244
Mailing Address - Street 1:800 S SAWBURG AVE
Mailing Address - Street 2:
Mailing Address - City:ALLIANCE
Mailing Address - State:OH
Mailing Address - Zip Code:44601-2715
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:330-821-7533
Practice Address - Street 1:800 S SAWBURG AVE
Practice Address - Street 2:
Practice Address - City:ALLIANCE
Practice Address - State:OH
Practice Address - Zip Code:44601-2715
Practice Address - Country:US
Practice Address - Phone:330-821-7244
Practice Address - Fax:330-821-7533
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-20
Last Update Date:2011-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0387915Medicaid