Healthcare Provider Details

I. General information

NPI: 1841304854
Provider Name (Legal Business Name): SUMMIT DENTAL SPECIALISTS DRS GINDI AND VALIATHAN INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/18/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8600 ALEXANDRIA DR SUITE #B
MALEDONIA OH
44056
US

IV. Provider business mailing address

8600 ALEXANDRIA DR SUITE #B
MALEDONIA OH
44056
US

V. Phone/Fax

Practice location:
  • Phone: 330-467-2763
  • Fax: 330-467-2768
Mailing address:
  • Phone: 330-467-2763
  • Fax: 330-467-2768

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number21785
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number21417
License Number StateOH

VIII. Authorized Official

Name: DR. DANIEL MAURICE GINDI
Title or Position: VP SEC
Credential: DMD
Phone: 330-467-2763