Healthcare Provider Details

I. General information

NPI: 1386398196
Provider Name (Legal Business Name): DENTAL HEALTH ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/10/2022
Last Update Date: 02/10/2022
Certification Date: 02/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 W AIRPORT HWY
SWANTON OH
43558-1441
US

IV. Provider business mailing address

PO BOX 270
SWANTON OH
43558-0270
US

V. Phone/Fax

Practice location:
  • Phone: 419-826-2525
  • Fax: 419-825-5067
Mailing address:
  • Phone: 419-826-2525
  • Fax: 419-825-5067

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. ALISON JOHNSON
Title or Position: OWNER
Credential: DDS
Phone: 419-826-2525