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General NPI Number Information
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NPI Number | 1649686676
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Entity Type | Organization
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Legal Business Name | NORTH BALTIMORE DENTAL, MARK R. BEDFORD DDS INC.
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Dates
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Enumeration Date | 07/10/2014
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Last Update Date | 07/10/2014
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Provider Practice Location Address
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Address Line | 19680 IDLEWOOD TRL
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City | STRONGSVILLE
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State | OH
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Zip | 44149-3136
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Country | US
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Telephone | 440-572-1757
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Fax | 440-234-7820
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Provider Business Mailing Address
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Address Line | 19680 IDLEWOOD TRL
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City | STRONGSVILLE
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State | OH
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Zip | 44149-3136
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Country | US
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Telephone | 440-572-1757
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Fax | 440-234-7820
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Authorized Official
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Title or Position | PRESIDENT
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Name | MARK R. BEDFORD
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Credential | DDS
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Telephone | 440-292-5773
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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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