Organization
DENTAL STUDIO OF AVON LAKE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CHARLYNE JUNGERMANN (OFFICE MANAGER)
(440) 899-7950
Entity
Organization
Contact information
Practice address
32713 WALKER RD, AVON LAKE, OH 44012-2232
(440) 933-7950
Mailing address
32713 WALKER RD, AVON LAKE, OH 44012-2232
(440) 933-7950
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1326136896
NPI
—
01
—
1497180889
NPI
—
Enumeration date
06/13/2019
Last updated
06/13/2019
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