Provider Demographics
NPI:1982128773
Name:PERIODONTICS OF TOLEDO
Entity Type:Organization
Organization Name:PERIODONTICS OF TOLEDO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:G
Authorized Official - Last Name:RULE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:419-473-1222
Mailing Address - Street 1:4447 TALMADGE RD. SUITE F
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43623
Mailing Address - Country:US
Mailing Address - Phone:419-473-1222
Mailing Address - Fax:419-473-1452
Practice Address - Street 1:223 W. CRAWFORD
Practice Address - Street 2:
Practice Address - City:FINDLAY
Practice Address - State:OH
Practice Address - Zip Code:45840
Practice Address - Country:US
Practice Address - Phone:419-473-1222
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-02
Last Update Date:2017-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH167461223P0300X
OH30.0236631223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Single Specialty