Provider Demographics
NPI:1952527376
Name:DENTAL CENTEROF NORTHWEST OHIO
Entity Type:Organization
Organization Name:DENTAL CENTEROF NORTHWEST OHIO
Other - Org Name:DCNWO BLANCHARD VALLEY CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MELINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:CREE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:419-241-1644
Mailing Address - Street 1:2138 MADISON AVE.
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43604
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1800 N BLANCHARD ST
Practice Address - Street 2:SUITE 122
Practice Address - City:FINDLAY
Practice Address - State:OH
Practice Address - Zip Code:45840-4507
Practice Address - Country:US
Practice Address - Phone:419-422-7664
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0468659Medicaid