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General NPI Number Information
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NPI Number | 1356066062
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Entity Type | Organization
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Legal Business Name | LEHKY STATE DENTAL PROVIDERS, LLC
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Dates
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Enumeration Date | 10/05/2022
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Last Update Date | 10/05/2022
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Provider Practice Location Address
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Address Line | 2820 W MARKET ST STE 100
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City | FAIRLAWN
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State | OH
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Zip | 44333-4061
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Country | US
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Telephone | 330-864-3331
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Fax |
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Provider Business Mailing Address
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Address Line | 2820 W MARKET ST STE 100
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City | FAIRLAWN
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State | OH
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Zip | 44333-4061
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Country | US
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Telephone | 330-864-3331
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | TIFFANY R CREEK
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Credential | CDA
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Telephone | 330-224-9528
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 1223D0001X
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Taxonomy Name | Public Health Dentistry
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License Number |
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License Number State |
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