MEDICARE: MOGADORE DENTAL GROUP

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
1	122300000X	Dentist	30016997	OH
2	122300000X	Dentist	30016592	OH

General Provider Information

NPI Number	:	1356437214
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MOGADORE DENTAL GROUP

Provider Business Mailing Address
First Line	:	60 SOUTH CLEVELAND AVE
Second Line	:
City	:	MOGADORE
State	:	OH
Zip	:	44260-1442
Country	:	US
Telephone Number	:	330-628-2424
Fax Number	:	330-628-3533

Provider Business Practice Location Address
First Line	:	60 SOUTH CLEVELAND AVE
Second Line	:
City	:	MOGADORE
State	:	OH
Zip	:	44260-1442
Country	:	US
Telephone Number	:	330-628-2424
Fax Number	:	330-628-3533

Authorized Official
Title or Position	:	OWNER PARTNER
Name	:	DR. DENNIS JAMES NOLAN
Credential	:	DDS
Telephone Number	:	330-628-2424

Provider Enumeration Date	:	10/05/2006
Last Update Date	:	08/22/2020

Similar Medicare Providers

1033205992 — DR. DENNIS JAMES NOLAN DDS
Practice Location Address:

60 SOUTH CLEVELAND AVE
MOGADORE, OH
44260-1442

Practice Phone: 330-628-2424
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1013003979 — DR. BRIAN LEE VOGELSANG DMD
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1275370959 — JENNIFER LYNN WYROCK GRANO AGNP-C
Practice Location Address:

754 S CLEVELAND AVE STE 300
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Practice Fax:

1174470249 — MR. THOMAS N. KINTZ
Practice Location Address:

4060 HIGHLAND DR
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1881698413 — BRENDA S BUIS D.O.
Practice Location Address:

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1417951039 — BRIAN R CAIN M.D.
Practice Location Address:

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Directions to “MOGADORE DENTAL GROUP ” Practice Location

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