Organization
KIDSMILE, INC. - JOHN M. VENZEL, D.M.D.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JOHN MATTHEW VENZEL D.M.D. (MEMBER)
(440) 934-2600
Entity
Organization
Contact information
Practice address
37701 COLORADO AVE, SUITE E, AVON, OH 44011-2840
(440) 934-2600
(440) 934-2602
Mailing address
37701 COLORADO AVE, SUITE E, AVON, OH 44011-2840
(440) 934-2600
(440) 934-2602
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
30.017951
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0603716
—
OH
01
—
603882
COMPBENEFITS PROVIDER ID
OH
01
—
774120
UNITED CONCORDIA PROVIDER
OH
Enumeration date
02/24/2006
Last updated
08/22/2020
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