Healthcare Provider Details

I. General information

NPI: 1891865507
Provider Name (Legal Business Name): ASHTABULA DENTAL ASSOCIATES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/09/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5005 STATE RD
ASHTABULA OH
44004-6265
US

IV. Provider business mailing address

5005 STATE RD
ASHTABULA OH
44004-6265
US

V. Phone/Fax

Practice location:
  • Phone: 440-992-3146
  • Fax: 440-998-6932
Mailing address:
  • Phone: 440-992-3146
  • Fax: 440-998-6932

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number
License Number State
# 7
Primary TaxonomyY
Taxonomy Code126800000X
TaxonomyDental Assistant
License Number
License Number State

VIII. Authorized Official

Name: DR. WILLIAM PAUL SOCKMAN
Title or Position: PRESIDENT
Credential: D.D.S.
Phone: 440-992-3146