Provider Demographics
NPI:1952720070
Name:BUCKEYE DENTAL SERVICES, GEOFFREY FRONING D.D.S. INC.
Entity Type:Organization
Organization Name:BUCKEYE DENTAL SERVICES, GEOFFREY FRONING D.D.S. INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GEOFFREY
Authorized Official - Middle Name:
Authorized Official - Last Name:FRONING
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:567-644-4438
Mailing Address - Street 1:1031 RICHIE AVE
Mailing Address - Street 2:
Mailing Address - City:LIMA
Mailing Address - State:OH
Mailing Address - Zip Code:45805-2051
Mailing Address - Country:US
Mailing Address - Phone:419-228-3384
Mailing Address - Fax:
Practice Address - Street 1:1031 RICHIE AVE
Practice Address - Street 2:
Practice Address - City:LIMA
Practice Address - State:OH
Practice Address - Zip Code:45805-2051
Practice Address - Country:US
Practice Address - Phone:419-228-3384
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-16
Last Update Date:2014-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH215061223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2436699Medicaid