Organization
LORAIN COUNTY HEALTH & DENTISTRY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
STEPHANIE WIERSMA (PRESIDENT & CEO)
(440) 233-1059
Entity
Organization
Contact information
Practice address
3745 GROVE AVE, LORAIN, OH 44055
(440) 240-1655
(440) 245-1218
Mailing address
1205 BROADWAY, LORAIN, OH 44052-3409
(440) 240-1655
(440) 245-1218
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
—
—
204E00000X
Oral & Maxillofacial Surgery (D.M.D.)
—
—
207Q00000X
Family Medicine Physician
—
—
207R00000X
Internal Medicine Physician
—
—
207V00000X
Obstetrics & Gynecology Physician
—
—
208000000X
Pediatrics Physician
—
—
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2500841
—
OH
01
—
CJ8620
MEDICARE RAILROAD
OH
Enumeration date
04/28/2008
Last updated
09/30/2013
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