Organization
WESTERN LAKE ERIE OMS LTD.
Active
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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