Healthcare Provider Details

I. General information

NPI: 1982128773
Provider Name (Legal Business Name): PERIODONTICS OF TOLEDO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/02/2017
Last Update Date: 08/02/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

223 W. CRAWFORD
FINDLAY OH
45840
US

IV. Provider business mailing address

4447 TALMADGE RD. SUITE F
TOLEDO OH
43623
US

V. Phone/Fax

Practice location:
  • Phone: 419-473-1222
  • Fax:
Mailing address:
  • Phone: 419-473-1222
  • Fax: 419-473-1452

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number30.023663
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number16746
License Number StateOH

VIII. Authorized Official

Name: MS. JULIE G. RULE
Title or Position: OFFICE MANAGER
Credential:
Phone: 419-473-1222