Organization
EDP OF OHIO, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ROSEANNE BRUNENKANT (DIRECTOR OF INTEGRATIONS)
(312) 937-3619
Entity
Organization
Contact information
Practice address
3210 BRIARFIELD BLVD, MAUMEE, OH 43537-9501
(419) 866-2400
Mailing address
141 W JACKSON BLVD STE 210, CHICAGO, IL 60604-3048
(312) 937-3619
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Enumeration date
12/27/2017
Last updated
09/16/2019
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