Provider Demographics
NPI:1356066062
Name:LEHKY STATE DENTAL PROVIDERS, LLC
Entity type:Organization
Organization Name:LEHKY STATE DENTAL PROVIDERS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:TIFFANY
Authorized Official - Middle Name:R
Authorized Official - Last Name:CREEK
Authorized Official - Suffix:
Authorized Official - Credentials:CDA
Authorized Official - Phone:330-224-9528
Mailing Address - Street 1:2820 W MARKET ST STE 100
Mailing Address - Street 2:
Mailing Address - City:FAIRLAWN
Mailing Address - State:OH
Mailing Address - Zip Code:44333-4061
Mailing Address - Country:US
Mailing Address - Phone:330-864-3331
Mailing Address - Fax:
Practice Address - Street 1:2820 W MARKET ST STE 100
Practice Address - Street 2:
Practice Address - City:FAIRLAWN
Practice Address - State:OH
Practice Address - Zip Code:44333-4061
Practice Address - Country:US
Practice Address - Phone:330-864-3331
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-05
Last Update Date:2022-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223D0001XDental ProvidersDentistDental Public HealthGroup - Multi-Specialty
No261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDentalGroup - Multi-Specialty