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NPI Code Detail

MEDICARE: MAHONING AVENUE DENTAL HEALTH CENTER MICHAEL CRITES DDS INC

MEDICARE: MAHONING AVENUE DENTAL HEALTH CENTER MICHAEL CRITES DDS INC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11223G0001XGeneral Practice Dentistry30019501OH

General Provider Information

NPI Number : 1225447709
Entity Type Code : Organization
Provider Name (Legal Business Name) : MAHONING AVENUE DENTAL HEALTH CENTER MICHAEL CRITES DDS INC
Provider Business Mailing Address
First Line : 3353 MAHONING AVE
Second Line :
City : YOUNGSTOWN
State : OH
Zip : 44509-2617
Country : US
Telephone Number : 330-792-9600
Fax Number :
Provider Business Practice Location Address
First Line : 3353 MAHONING AVE
Second Line :
City : YOUNGSTOWN
State : OH
Zip : 44509-2617
Country : US
Telephone Number : 330-792-9600
Fax Number :
Authorized Official
Title or Position : SR. CREDENTIALING SPECIALIST
Name : MAGGI EVANS
Credential :
Telephone Number : 720-272-7558
Provider Enumeration Date : 08/08/2014
Last Update Date : 02/28/2025

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Directions to “MAHONING AVENUE DENTAL HEALTH CENTER MICHAEL CRITES DDS INC ” Practice Location

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