Organization
LAWRENCE COUNTY DENTAL SEALANT PROGRAM
Active
Organization subpart
No
Provider details
NPI number
Authorized official
HAROLD SHAFER (SUPERINTENDENT)
(740) 532-4223
Entity
Organization
Contact information
Practice address
111 S 4TH ST, THIRD FLOOR COURTHOUSE, IRONTON, OH 45638-1522
(740) 532-4223
Mailing address
111 S 4TH ST, THIRD FLOOR COURTHOUSE, IRONTON, OH 45638-1522
(740) 532-4223
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
17404
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2461545
—
OH
Enumeration date
01/31/2007
Last updated
08/22/2020
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