1982867149 NPI number — MERTES AKRON PEDIATRIC DENTISTRY

Table of content: (NPI 1982867149)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1982867149 NPI number — MERTES AKRON PEDIATRIC DENTISTRY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MERTES AKRON PEDIATRIC DENTISTRY
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1982867149
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/24/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5655 HUDSON DRIVE
Provider Second Line Business Mailing Address:
SUITE 300
Provider Business Mailing Address City Name:
HUDSON
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44236
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
330-655-5437
Provider Business Mailing Address Fax Number:
330-655-5435

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5655 HUDSON DR STE 300
Provider Second Line Business Practice Location Address:
STE 300
Provider Business Practice Location Address City Name:
HUDSON
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44236-4454
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
330-761-3430
Provider Business Practice Location Address Fax Number:
330-655-5435
Provider Enumeration Date:
07/08/2008

Additional Information

Authorized Official

Authorized Official Last Name:
MERTES
Authorized Official First Name:
GREGORY
Authorized Official Middle Name:
C
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
330-655-5437

Provider Taxonomy Codes

  • Taxonomy code: 1223P0221X , with the licence number:  3021515 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 2482764 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".




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