Healthcare Provider Details

I. General information

NPI: 1700122272
Provider Name (Legal Business Name): MOHR SMILES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/02/2013
Last Update Date: 01/02/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

664 ELIDA AVE
DELPHOS OH
45833-1735
US

IV. Provider business mailing address

664 ELIDA AVE
DELPHOS OH
45833-1735
US

V. Phone/Fax

Practice location:
  • Phone: 419-692-4746
  • Fax: 419-692-0270
Mailing address:
  • Phone: 419-692-4746
  • Fax: 419-692-0270

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number3021918
License Number StateOH

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: JACOB MOHR
Title or Position: PRESIDENT/OWNER
Credential: D.D.S.
Phone: 419-203-6215