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General NPI Number Information
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NPI Number | 1841462843
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Entity Type | Organization
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Legal Business Name | KENNETH D. LAPOLLA, D.D.S,, INC
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Dates
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Enumeration Date | 03/31/2008
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Last Update Date | 03/31/2008
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Provider Practice Location Address
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Address Line | 8588 E MARKET ST
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City | WARREN
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State | OH
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Zip | 44484-2339
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Country | US
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Telephone | 330-609-6565
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Fax |
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Provider Business Mailing Address
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Address Line | 8588 E MARKET ST
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City | WARREN
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State | OH
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Zip | 44484-2339
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Country | US
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Telephone | 330-609-6565
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. KENNETH DOMINIC LAPOLLA
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Credential | DDS
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Telephone | 330-609-6565
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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 | 3019432
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License Number State | OH
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