Organization
STREETSBORO DENTAL PARTNERS INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LYDIA HARTMAN (CREDENTIALING ADMINISTRATOR)
(330) 626-3814
Entity
Organization
Contact information
Practice address
1727 STREETSBORO PLZ, STREETSBORO, OH 44241-5635
(330) 626-3814
(330) 626-2169
Mailing address
PO BOX 2006, 1727 STREETSBORO PLAZA, STREETSBORO, OH 44241-0006
(330) 626-3814
(330) 626-2169
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
20624
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2029361
—
OH
Enumeration date
05/20/2008
Last updated
09/28/2016
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