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General NPI Number Information
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NPI Number | 1073525689
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Entity Type | Organization
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Legal Business Name | MAHONING VALLEY DENTAL SERVICES
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Dates
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Enumeration Date | 08/12/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 5100 BELMONT AVE SUITE 1
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City | YOUNGSTOWN
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State | OH
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Zip | 44505-1043
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Country | US
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Telephone | 330-759-1771
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Fax | 330-759-1227
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Provider Business Mailing Address
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Address Line | 5100 BELMONT AVE SUITE 1
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City | YOUNGSTOWN
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State | OH
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Zip | 44505-1043
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Country | US
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Telephone | 330-759-1711
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Fax | 330-759-1227
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MS. LISA A MORELLA
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Credential |
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Telephone | 330-759-1771
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number |
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License Number State |
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