| Leidenheimer Dental Group, Inc. | |
|
42707 N Ridge Rd Elyria OH 44035-1054 | |
| (440) 444-0379 | |
| (440) 654-2778 |
| Full Name | Leidenheimer Dental Group, Inc. |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 42707 N Ridge Rd, Elyria, Ohio |
| Authorized Official Name and Position | Jennifer A Sochacki (OFFICE MANAGER/TREASURER) |
| Authorized Official Contact | 4404440379 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Leidenheimer Dental Group, Inc. 42707 N Ridge Rd Elyria OH 44035-1054 Ph: (440) 444-0379 | Leidenheimer Dental Group, Inc. 42707 N Ridge Rd Elyria OH 44035-1054 Ph: (440) 444-0379 |
| NPI Number | 1750551479 |
|---|---|
| Provider Enumeration Date | 03/10/2008 |
| Last Update Date | 06/02/2015 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1750551479 | NPI | - | NPPES |
| 2825410 | Medicaid | OH | |
| 0015325 | Medicaid | OH | |
| 2093907 | Medicaid | OH | |
| 2203538 | Medicaid | OH | |
| 3107033 | Medicaid | OH | |
| 4614975 | Medicaid | OH |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | 30020876 (Ohio) | Primary |
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