Provider Demographics
NPI:1780691717
Name:MAHONING VALLEY DENTAL SERVICES
Entity type:Organization
Organization Name:MAHONING VALLEY DENTAL SERVICES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:CASTILLA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:330-856-2880
Mailing Address - Street 1:433 NILES CORTLAND ROAD NE
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:OH
Mailing Address - Zip Code:44484-1943
Mailing Address - Country:US
Mailing Address - Phone:330-856-2880
Mailing Address - Fax:330-856-9985
Practice Address - Street 1:433 NILES CORTLAND ROAD NE
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:OH
Practice Address - Zip Code:44484-1943
Practice Address - Country:US
Practice Address - Phone:330-856-2880
Practice Address - Fax:330-856-9985
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty