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130 S Market St Wooster OH 44691-4839 | |
| (330) 264-9678 | |
| (330) 264-0890 |
| Full Name | |
|---|---|
| Speciality | Clinic/center - Dental |
| Location | 130 S Market St, Wooster, Ohio |
| Authorized Official Name and Position | Krikor P. Ghazarian (OWNER) |
| Authorized Official Contact | 3302649678 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
130 S Market St Wooster OH 44691-4839 Ph: (330) 264-9678 | 130 S Market St Wooster OH 44691-4839 Ph: (330) 264-9678 |
| NPI Number | 1811043136 |
|---|---|
| Provider Enumeration Date | 01/27/2007 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1811043136 | NPI | - | NPPES |
| 2480257 | Medicaid | OH |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | 17656 (Ohio) | Primary |
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