MEDICARE: DENTAL SERVICES OF NORTHERN OHIO

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	1223G0001X	General Practice Dentistry

General Provider Information

NPI Number	:	1538333224
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DENTAL SERVICES OF NORTHERN OHIO

Provider Business Mailing Address
First Line	:	1698 W MARKET ST
Second Line	:
City	:	AKRON
State	:	OH
Zip	:	44313-7002
Country	:	US
Telephone Number	:	330-864-3000
Fax Number	:	330-864-3003

Provider Business Practice Location Address
First Line	:	1698 W MARKET ST
Second Line	:
City	:	AKRON
State	:	OH
Zip	:	44313-7002
Country	:	US
Telephone Number	:	330-864-3000
Fax Number	:	330-864-3003

Authorized Official
Title or Position	:	CREDENTIALING COORDINATOR
Name	:	JADA HUSS
Credential	:	CPCS
Telephone Number	:	816-268-8340

Provider Enumeration Date	:	04/15/2008
Last Update Date	:	04/15/2008

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Directions to “DENTAL SERVICES OF NORTHERN OHIO ” Practice Location

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