Organization
OHIO STREET FAMILY DENTAL GROUP, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. SHEONA KIMMEL (OFFICE MANAGER)
(440) 937-8878
Entity
Organization
Contact information
Practice address
406 OHIO ST, ELYRIA, OH 44035-3925
(440) 937-8878
Mailing address
5201 N ABBE RD, SHEFFIELD VILLAGE, OH 44035-1451
(440) 937-8878
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
30.020075
OH
Other
Enumeration date
06/19/2018
Last updated
06/19/2018
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