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General NPI Number Information
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NPI Number | 1609323831
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Entity Type | Organization
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Legal Business Name | COMPLETE DENTAL CARE OF SHADYSIDE
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Dates
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Enumeration Date | 09/06/2016
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Last Update Date | 09/06/2016
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Provider Practice Location Address
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Address Line | 3775 CENTRAL AVE
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City | SHADYSIDE
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State | OH
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Zip | 43947-1344
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Country | US
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Telephone | 740-676-2604
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Fax | 740-676-2604
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Provider Business Mailing Address
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Address Line | 2700 SUNSET BLVD
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City | STEUBENVILLE
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State | OH
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Zip | 43952-1158
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Country | US
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Telephone | 740-264-6811
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Fax | 740-264-6812
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | ARMANDA LESTER
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Credential |
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Telephone | 740-485-0309
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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 | 30.016390
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 30.024551
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License Number State | OH
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Taxonomy #3
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 30.24884
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License Number State | OH
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Taxonomy #4
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 30.023979
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License Number State | OH
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