Organization
OHIO DENTAL PROFESSIONALS, DELISLE, P.C.
Active
Parent organization
OHIO DENTAL PROFESSIONALS, DELISLE, P.C.
Other names
Lake West Dental
Organization subpart
Yes
Provider details
NPI number
Legal business name
OHIO DENTAL PROFESSIONALS, DELISLE, P.C.
Authorized official
HILLARY THULL (CREDENTIALING COORDINATOR)
(217) 540-8946
Entity
Organization
Contact information
Practice address
2770 SOM CENTER RD STE 1, WILLOUGHBY HILLS, OH 44094-9116
(440) 473-4746
Mailing address
2770 SOM CENTER RD STE 1, WILLOUGHBY HILLS, OH 44094-9116
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Enumeration date
04/17/2024
Last updated
04/17/2024
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