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General NPI Number Information
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NPI Number | 1740035468
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Entity Type | Organization
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Legal Business Name | ELLERHORST DENTAL, LLC
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Dates
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Enumeration Date | 04/17/2024
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Last Update Date | 04/17/2024
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Provider Practice Location Address
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Address Line | 10730 MAIN ST APT 2
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City | MANTUA
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State | OH
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Zip | 44255-8951
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Country | US
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Telephone | 330-274-3495
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 350
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City | MANTUA
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State | OH
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Zip | 44255-0350
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Country | US
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Telephone | 330-221-4270
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Fax |
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Authorized Official
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Title or Position | DENTIST/OWNER
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Name | MRS. LYDIA ELLERHORST
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Credential | DDS
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Telephone | 330-221-4270
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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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