Provider Demographics
NPI:1740842996
Name:AMHERST DENTAL ASSOCIATES
Entity type:Organization
Organization Name:AMHERST DENTAL ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CHARLYNE
Authorized Official - Middle Name:
Authorized Official - Last Name:JUNGERMANN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:440-988-5711
Mailing Address - Street 1:255 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:AMHERST
Mailing Address - State:OH
Mailing Address - Zip Code:44001-2158
Mailing Address - Country:US
Mailing Address - Phone:440-988-5711
Mailing Address - Fax:
Practice Address - Street 1:255 S MAIN ST
Practice Address - Street 2:
Practice Address - City:AMHERST
Practice Address - State:OH
Practice Address - Zip Code:44001-2158
Practice Address - Country:US
Practice Address - Phone:440-988-5711
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-08
Last Update Date:2019-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH20914OtherLICENSE