Provider Demographics
NPI:1740330489
Name:MUNROE FALLS FAMILY DENTISTRY CO
Entity type:Organization
Organization Name:MUNROE FALLS FAMILY DENTISTRY CO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:R
Authorized Official - Last Name:EVAN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:330-688-4942
Mailing Address - Street 1:PO BOX 216
Mailing Address - Street 2:425 N MAIN ST
Mailing Address - City:MUNROE FALLS
Mailing Address - State:OH
Mailing Address - Zip Code:44262
Mailing Address - Country:US
Mailing Address - Phone:330-688-4942
Mailing Address - Fax:330-688-9064
Practice Address - Street 1:425 N MAIN ST
Practice Address - Street 2:
Practice Address - City:MUNROE FALLS
Practice Address - State:OH
Practice Address - Zip Code:44262
Practice Address - Country:US
Practice Address - Phone:330-688-4942
Practice Address - Fax:330-688-9064
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty