Provider Demographics
NPI:1720251200
Name:DARBY CREEK DENTAL, INC. - DAVID W. CLEVELAND, D.D.S.
Entity Type:Organization
Organization Name:DARBY CREEK DENTAL, INC. - DAVID W. CLEVELAND, D.D.S.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JAQUELIN
Authorized Official - Middle Name:R
Authorized Official - Last Name:WUETHRICH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:937-644-8822
Mailing Address - Street 1:137 DAMASCUS RD
Mailing Address - Street 2:
Mailing Address - City:MARYSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43040-9618
Mailing Address - Country:US
Mailing Address - Phone:937-644-8822
Mailing Address - Fax:937-644-1621
Practice Address - Street 1:137 DAMASCUS RD
Practice Address - Street 2:
Practice Address - City:MARYSVILLE
Practice Address - State:OH
Practice Address - Zip Code:43040-9618
Practice Address - Country:US
Practice Address - Phone:937-644-8822
Practice Address - Fax:937-644-1621
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-07
Last Update Date:2017-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH215611223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty