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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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