Organization
FAMILY DENTISTRY ON THE SQUARE, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ROBERT R GUTHRIE D.D.S. (OWNER/DENTIST)
(330) 336-5788
Entity
Organization
Contact information
Practice address
111 MAIN ST, WADSWORTH, OH 44281-1433
(330) 336-5788
(330) 334-1425
Mailing address
111 MAIN ST, WADSWORTH, OH 44281-1433
(330) 336-5788
(330) 334-1425
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
30-16242
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0407018
—
OH
Enumeration date
09/15/2016
Last updated
09/15/2016
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