Organization
WESTERN LAKE ERIE OMS LTD.
Active
Other names
Western Lake Erie OMS Ltd.
Organization subpart
No
Provider details
NPI number
Authorized official
STEPHEN MARK SHALL D.D.S. (PRESIDENT)
(419) 479-3939
Entity
Organization
Contact information
Practice address
5690 MONROE ST, SYLVANIA, OH 43560-2736
(419) 479-3939
(419) 479-3933
Mailing address
5690 MONROE ST, SYLVANIA, OH 43560-2736
(419) 479-3939
(419) 479-3933
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
—
—
261QS0112X
Oral and Maxillofacial Surgery Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1215932504
NPI NUMBER
OH
01
—
1578568861
NPI NUMBER
OH
01
—
1891795233
NPI NUMBER
OH
Enumeration date
05/02/2007
Last updated
07/31/2019
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