Provider Demographics
NPI:1356437214
Name:MOGADORE DENTAL GROUP
Entity type:Organization
Organization Name:MOGADORE DENTAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:NOLAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:330-628-2424
Mailing Address - Street 1:60 SOUTH CLEVELAND AVE
Mailing Address - Street 2:
Mailing Address - City:MOGADORE
Mailing Address - State:OH
Mailing Address - Zip Code:44260-1442
Mailing Address - Country:US
Mailing Address - Phone:330-628-2424
Mailing Address - Fax:330-628-3533
Practice Address - Street 1:60 SOUTH CLEVELAND AVE
Practice Address - Street 2:
Practice Address - City:MOGADORE
Practice Address - State:OH
Practice Address - Zip Code:44260-1442
Practice Address - Country:US
Practice Address - Phone:330-628-2424
Practice Address - Fax:330-628-3533
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30016997122300000X
OH30016592122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty