Healthcare Provider Details

I. General information

NPI: 1467543157
Provider Name (Legal Business Name): ORTHODONTIC ASSOCIATES, DRS. AHMAN AND JANOWSKI, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/27/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

260 S EASTOWN RD
LIMA OH
45807-2200
US

IV. Provider business mailing address

260 S EASTOWN RD
LIMA OH
45807-2200
US

V. Phone/Fax

Practice location:
  • Phone: 419-229-8771
  • Fax: 419-224-2514
Mailing address:
  • Phone: 419-229-8771
  • Fax: 419-224-2514

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number15389
License Number StateOH

VII. Legacy identifiers

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

VIII. Authorized Official

Name: DR. THOMAS LEE AHMAN
Title or Position: PRESIDENT
Credential: D.D.S., M.S.
Phone: 419-229-8771