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General NPI Number Information
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NPI Number | 1275714651
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Entity Type | Organization
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Legal Business Name | MDC OF OHIO
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Dates
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Enumeration Date | 11/14/2007
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Last Update Date | 07/02/2008
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Provider Practice Location Address
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Address Line | 1359 S HOLLAND SYLVANIA RD
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City | HOLLAND
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State | OH
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Zip | 43528-8423
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Country | US
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Telephone | 419-865-4441
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Fax | 419-865-9032
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Provider Business Mailing Address
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Address Line | 1359 S HOLLAND SYLVANIA RD
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City | HOLLAND
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State | OH
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Zip | 43528-8423
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Country | US
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Telephone | 419-865-4441
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Fax | 419-865-9032
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Authorized Official
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Title or Position | PRESIDENT
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Name | MARK BEDFORD
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Credential | DDS
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Telephone | 419-865-4441
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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 | 15902
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License Number State | OH
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