Healthcare Provider Details

I. General information

NPI: 1093988859
Provider Name (Legal Business Name): NORTH LIMA DENTAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/11/2008
Last Update Date: 04/11/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11695 MARKET ST
NORTH LIMA OH
44452
US

IV. Provider business mailing address

11695 MARKET ST PO BOX 304
NORTH LIMA OH
44452
US

V. Phone/Fax

Practice location:
  • Phone: 330-549-2800
  • Fax: 330-549-2660
Mailing address:
  • Phone: 330-549-2800
  • Fax: 330-549-2660

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: MR. FRANK PETRAKOS
Title or Position: OWNER
Credential: DDS
Phone: 330-549-2800