Organization
BEREA FAMILY DENTAL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KATHY NELSON (PRACTICE ADMINISTRATOR)
(937) 206-4080
Entity
Organization
Contact information
Practice address
20 S LIMESTONE ST, SUITE110, SPRINGFIELD, OH 45502-2219
(937) 322-7832
Mailing address
359 FRONT ST, BEREA, OH 44017-1760
(440) 234-2813
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
15902
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0431321
—
OH
05
—
2809232
—
OH
Enumeration date
04/03/2015
Last updated
04/03/2015
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