| 555 W Elm St Dentistry Llc | |
|
555 W Elm St Lima OH 45801-4757 | |
| (419) 229-0776 | |
| (419) 229-3828 |
| Full Name | 555 W Elm St Dentistry Llc |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 555 W Elm St, Lima, Ohio |
| Authorized Official Name and Position | David Wayne Hancock (OWNER) |
| Authorized Official Contact | 4192290776 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| 555 W Elm St Dentistry Llc 555 W Elm St Lima OH 45801-4757 Ph: (419) 229-0776 | 555 W Elm St Dentistry Llc 555 W Elm St Lima OH 45801-4757 Ph: (419) 229-0776 |
| NPI Number | 1043351034 |
|---|---|
| Provider Enumeration Date | 02/10/2007 |
| Last Update Date | 03/19/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1043351034 | NPI | - | NPPES |
| 2081376 | Medicaid | OH |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | 30 . 20842 (Ohio) | Primary |
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