Organization
555 W ELM ST DENTISTRY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DAVID WAYNE HANCOCK (OWNER)
(419) 229-0776
Entity
Organization
Contact information
Practice address
555 W ELM ST, LIMA, OH 45801-4757
(419) 229-0776
(419) 229-3828
Mailing address
555 W ELM ST, LIMA, OH 45801-4757
(419) 229-0776
(419) 229-3828
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
30 . 20842
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2081376
—
OH
Enumeration date
02/10/2007
Last updated
03/19/2008
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