Healthcare Provider Details

I. General information

NPI: 1154330694
Provider Name (Legal Business Name): EUGENE SCHLANK D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/05/2006
Last Update Date: 02/22/2024
Certification Date: 02/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6540 SOUTH AVE
BOARDMAN OH
44512-3651
US

IV. Provider business mailing address

9605 OLD STABLE CT
MASON OH
45040-8637
US

V. Phone/Fax

Practice location:
  • Phone: 330-758-6165
  • Fax:
Mailing address:
  • Phone: 216-956-9748
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number0401007638
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number16794
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: