Provider Demographics
NPI:1336902303
Name:MAURER AND DENTAL ASSOCIATES OF STOW COMPANY
Entity Type:Organization
Organization Name:MAURER AND DENTAL ASSOCIATES OF STOW COMPANY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIR. CREDENTIALING AND ENROLLMENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:JACOMINO-BARNES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-270-9497
Mailing Address - Street 1:PO BOX 70887
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44190-6968
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3515 HUDSON DR STE 100
Practice Address - Street 2:
Practice Address - City:STOW
Practice Address - State:OH
Practice Address - Zip Code:44224-6968
Practice Address - Country:US
Practice Address - Phone:330-928-7674
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-02
Last Update Date:2024-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty