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General NPI Number Information
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NPI Number | 1093521205
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Entity Type | Organization
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Legal Business Name | FAMILY FIRST DENTAL GROUP, LLC
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Dates
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Enumeration Date | 12/04/2024
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Last Update Date | 12/04/2024
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Provider Practice Location Address
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Address Line | 542 NILES-CORTLAND RD SE
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City | WARREN
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State | OH
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Zip | 44484
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Country | US
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Telephone | 330-856-3320
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Fax | 330-856-7912
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Provider Business Mailing Address
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Address Line | 542 NILES-CORTLAND RD SE
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City | WARREN
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State | OH
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Zip | 44484
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Country | US
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Telephone | 330-856-3320
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Fax | 330-856-7912
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Authorized Official
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Title or Position | FINANCIAL ADMINISTRATOR
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Name | LAURA L BAKER
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Credential |
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Telephone | 330-856-3320
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State |
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