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1019 N Park Ave Warren OH 44483-3725 | |
| (330) 395-3820 | |
| (330) 392-7406 |
| Full Name | |
|---|---|
| Speciality | Dentist |
| Location | 1019 N Park Ave, Warren, Ohio |
| Authorized Official Name and Position | Angela Wilk (OFFICE MANAGER) |
| Authorized Official Contact | 3303953820 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
1019 N Park Ave Warren OH 44483-3725 Ph: () - | 1019 N Park Ave Warren OH 44483-3725 Ph: (330) 395-3820 |
| NPI Number | 1558860130 |
|---|---|
| Provider Enumeration Date | 02/08/2018 |
| Last Update Date | 02/08/2018 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1558860130 | NPI | - | NPPES |
| 0143560 | Medicaid | OH | |
| 0520341 | Medicaid | OH | |
| 0055702 | Medicaid | OH |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | 30.20746 (Ohio) | Primary |
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