Provider Demographics
NPI:1952820102
Name:CANDM CONSULTING LLC
Entity Type:Organization
Organization Name:CANDM CONSULTING LLC
Other - Org Name:OHIO PEDIATRIC DENTAL ANESTHESIA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICIAN/EMPLOYEE
Authorized Official - Prefix:DR
Authorized Official - First Name:MOIRA
Authorized Official - Middle Name:
Authorized Official - Last Name:GIOITTA-TUCKER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:330-598-1556
Mailing Address - Street 1:4100 DERRWOOD DR
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44333-1134
Mailing Address - Country:US
Mailing Address - Phone:330-598-1556
Mailing Address - Fax:330-294-4331
Practice Address - Street 1:4100 DERRWOOD DR
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44333-1134
Practice Address - Country:US
Practice Address - Phone:330-598-1556
Practice Address - Fax:330-294-4331
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-19
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.075780207L00000X, 207LP3000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP3000XAllopathic & Osteopathic PhysiciansAnesthesiologyPediatric AnesthesiologyGroup - Single Specialty
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty