Healthcare Provider Details

I. General information

NPI: 1720004732
Provider Name (Legal Business Name): SYLVANIA PEDIATRIC DENTAL CARE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/14/2006
Last Update Date: 06/28/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5860 ALEXIS RD
SYLVANIA OH
43560-2347
US

IV. Provider business mailing address

5860 ALEXIS RD
SYLVANIA OH
43560-2347
US

V. Phone/Fax

Practice location:
  • Phone: 419-882-7187
  • Fax: 419-882-3165
Mailing address:
  • Phone: 419-882-7187
  • Fax: 419-882-3165

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number
License Number State

VIII. Authorized Official

Name: JOE F INMAN
Title or Position: PRESIDENT
Credential: D.D.S.
Phone: 419-882-7187