Provider Demographics
NPI:1952551244
Name:LIMA COMMUNITY DENTAL-RISOLVATO, INC.
Entity Type:Organization
Organization Name:LIMA COMMUNITY DENTAL-RISOLVATO, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ERIK
Authorized Official - Middle Name:J
Authorized Official - Last Name:RISOLVATO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:419-228-4036
Mailing Address - Street 1:2115 ALLENTOWN RD
Mailing Address - Street 2:
Mailing Address - City:LIMA
Mailing Address - State:OH
Mailing Address - Zip Code:45805-1749
Mailing Address - Country:US
Mailing Address - Phone:419-228-4036
Mailing Address - Fax:419-228-6273
Practice Address - Street 1:2115 ALLENTOWN RD
Practice Address - Street 2:
Practice Address - City:LIMA
Practice Address - State:OH
Practice Address - Zip Code:45805-1749
Practice Address - Country:US
Practice Address - Phone:419-228-4036
Practice Address - Fax:419-228-6273
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LIMA COMMUNITY DENTAL-RISOLVATO,INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-09-24
Last Update Date:2008-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30021809122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty