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Organization
NORTHWEST OHIO DENTAL SPECILITY CENTER,LLC
Active
Organization
NORTHWEST OHIO DENTAL SPECILITY CENTER,LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. STACY LYNN FRESHOUR (PRACTICE ADMINISTRATOR)
(419) 592-9956
Entity
Organization
Contact information
Practice address
610 BROADMOOR AVE, NAPOLEON, OH 43545-1288
(419) 592-5854
(419) 930-6500
Mailing address
610 BROADMOOR AVE, NAPOLEON, OH 43545-1288
(419) 592-9956
(419) 930-6500
Taxonomy
Speciality
Code
Description
License number
State
1223P0300X
Periodontics
Primary
30022360
OH
Other
Enumeration date
05/17/2017
Last updated
06/12/2017
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