Provider Demographics
NPI:1265740625
Name:ALPHA DENTAL
Entity type:Organization
Organization Name:ALPHA DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MING SHENG
Authorized Official - Middle Name:
Authorized Official - Last Name:YU
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:567-224-8754
Mailing Address - Street 1:12906 STATE ROUTE 664 S
Mailing Address - Street 2:SUITE A7
Mailing Address - City:LOGAN
Mailing Address - State:OH
Mailing Address - Zip Code:43138-9260
Mailing Address - Country:US
Mailing Address - Phone:567-224-8745
Mailing Address - Fax:
Practice Address - Street 1:12906 STATE ROUTE 664 S
Practice Address - Street 2:SUITE A7
Practice Address - City:LOGAN
Practice Address - State:OH
Practice Address - Zip Code:43138-9260
Practice Address - Country:US
Practice Address - Phone:567-224-8745
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-20
Last Update Date:2010-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH9391631Medicare PIN