Healthcare Provider Details

I. General information

NPI: 1609894260
Provider Name (Legal Business Name): JOSEPH D BEDICH DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/18/2006
Last Update Date: 01/10/2024
Certification Date: 01/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

481 S HIGH ST
CORTLAND OH
44410-1437
US

IV. Provider business mailing address

481 S HIGH ST
CORTLAND OH
44410-1437
US

V. Phone/Fax

Practice location:
  • Phone: 330-637-7971
  • Fax: 330-637-8958
Mailing address:
  • Phone: 330-637-7971
  • Fax: 330-637-8958

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number18742
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: