Provider Demographics
NPI:1295912186
Name:DANVILLE FAMILY DENTAL, AARON F. LERG DDS, INC.
Entity type:Organization
Organization Name:DANVILLE FAMILY DENTAL, AARON F. LERG DDS, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:AARON
Authorized Official - Middle Name:F
Authorized Official - Last Name:LERG
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:740-599-6882
Mailing Address - Street 1:P.O. BOX 3
Mailing Address - Street 2:709 S. MARKET ST
Mailing Address - City:DANVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43014
Mailing Address - Country:US
Mailing Address - Phone:740-599-6882
Mailing Address - Fax:740-599-7479
Practice Address - Street 1:709 S. MARKET STREET
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:OH
Practice Address - Zip Code:43014
Practice Address - Country:US
Practice Address - Phone:740-599-6882
Practice Address - Fax:740-599-7479
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-23
Last Update Date:2019-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH21328122300000X
OH18224122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2231534Medicaid