Ohio Street Family Dental Group, LLC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

30.020075 Issued in OH

Legal business name

OHIO STREET FAMILY DENTAL GROUP, LLC

Practice address

406 Ohio St
Elyria, OH 44035-3925

Phone

(440) 937-8878

NPI assigned

Jun 19, 2018

Last updated

Jun 19, 2018By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mrs. Sheona Kimmel

Title

Office Manager

Phone

(440) 937-8878

Specialties & licenses 1

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1529366400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1529366400000",
    "number": "1083108435",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5201 N ABBE RD",
            "city": "SHEFFIELD VILLAGE",
            "state": "OH",
            "postal_code": "440351451",
            "telephone_number": "440-937-8878"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "406 OHIO ST",
            "city": "ELYRIA",
            "state": "OH",
            "postal_code": "440353925",
            "telephone_number": "440-937-8878"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OHIO STREET FAMILY DENTAL GROUP, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-06-19",
        "last_updated": "2018-06-19",
        "status": "A",
        "authorized_official_last_name": "KIMMEL",
        "authorized_official_first_name": "SHEONA",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "440-937-8878",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "OH",
            "license": "30.020075",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Janet Odell, OTRL
• Bonaventure Chukwuemeke Ogbechie, MD
• Ohio CVS Stores LLC (CVS Pharmacy 03997)
• Ohio CVS Stores LLC (CVS Pharmacy #16570)
• Ohio Spine and Body Inc
• Ohioguidestone
• Julie Olejko
• Ruby Oliver
• Terra Oliver, COTA/L
• Om Healthcare LLC

• General Practice Dentistry in Elyria, OH
• Providers in Elyria, OH by specialty
• General Practice Dentistry in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 19, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.