MEDICARE: DENTAL SERVICES OF OHIO

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	122300000X	Dentist
2	1223G0001X	General Practice Dentistry	30-018565	OH

General Provider Information

NPI Number	:	1871767301
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DENTAL SERVICES OF OHIO

Provider Business Mailing Address
First Line	:	PO BOX 11568
Second Line	:
City	:	OVERLAND PARK
State	:	KS
Zip	:	66207-4268
Country	:	US
Telephone Number	:	913-428-1670
Fax Number	:	913-800-6967

Provider Business Practice Location Address
First Line	:	726-730 HOWE RD.
Second Line	:
City	:	CUYAHOGA FALLS
State	:	OH
Zip	:	44221-5124
Country	:	US
Telephone Number	:	330-928-1900
Fax Number	:	913-800-6967

Authorized Official
Title or Position	:	CREDENTIALING COORDINATOR
Name	:	AMY WHEELER
Credential	:
Telephone Number	:	913-800-6952

Provider Enumeration Date	:	04/16/2008
Last Update Date	:	04/12/2017

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