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3140 Dustin Rd Oregon OH 43616-4341 | |
| (419) 750-6432 | |
| (419) 698-3484 |
| Full Name | |
|---|---|
| Speciality | Dentist - Pediatric Dentistry |
| Location | 3140 Dustin Rd, Oregon, Ohio |
| Authorized Official Name and Position | Magdalena Evans (SENIOR CREDENTIALING SPECIALIST) |
| Authorized Official Contact | 7202727558 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
3140 Dustin Rd Oregon OH 43616-4341 Ph: (419) 750-6432 | 3140 Dustin Rd Oregon OH 43616-4341 Ph: (419) 750-6432 |
| NPI Number | 1912697624 |
|---|---|
| Provider Enumeration Date | 05/08/2023 |
| Last Update Date | 06/23/2023 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1912697624 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223P0221X | Dentist - Pediatric Dentistry | (* (Not Available)) | Primary |
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