MEDICARE: CHIPPEWA CREEK DENTAL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry

General Provider Information

NPI Number	:	1639851629
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHIPPEWA CREEK DENTAL

Provider Business Mailing Address
First Line	:	10 W MAIN ST
Second Line	:
City	:	SEVILLE
State	:	OH
Zip	:	44273-8851
Country	:	US
Telephone Number	:	330-769-2918
Fax Number	:

Provider Business Practice Location Address
First Line	:	10 W MAIN ST
Second Line	:
City	:	SEVILLE
State	:	OH
Zip	:	44273-8851
Country	:	US
Telephone Number	:	330-769-2918
Fax Number	:

Authorized Official
Title or Position	:	OWNER DENTIST
Name	:	TROY STEINHILBER
Credential	:	DMD
Telephone Number	:	330-769-2918

Provider Enumeration Date	:	08/01/2023
Last Update Date	:	08/01/2023

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