Organization
CITY WIDE DENTAL SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARK JOSEPH HEENAN DMD (PRESIDENT)
(419) 693-4712
Entity
Organization
Contact information
Practice address
725 MIAMI ST, TOLEDO, OH 43605-2278
(419) 693-4712
(419) 693-4495
Mailing address
725 MIAMI ST, TOLEDO, OH 43605-2278
(419) 693-4712
(419) 693-4495
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
17029
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
04944
PARAMOUNT
OH
05
—
2618984
—
OH
Enumeration date
08/28/2006
Last updated
10/02/2007
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