NPIMap

Organization Active NPI

Meckler Dental Providers (Olmsted), Inc

  • General Practice Dentistry
  • North Olmsted, OH
National Provider Identifier
1093787624
Registry record updated Oct 19, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
30.017994 Issued in OH
Legal business name
MECKLER DENTAL PROVIDERS (OLMSTED), INC
Practice address
4710 Great Northern Blvd
North Olmsted, OH 44070-3427
Phone
(440) 716-6939
Fax
(216) 584-1004
NPI assigned
Feb 7, 2006
Organization subpart
Yes
Parent organization
DENTALONE PARTNERS, INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Oct 19, 2018

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

Authorized official

Name
Kathleen Stautihar
Title
Supervisor, Credentialing
Phone
(216) 584-1673

Specialties & licenses 9

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193200000X MULTI-SPECIALTY GROUP 122300000X
EndodonticsGroup: 193200000X MULTI-SPECIALTY GROUP 1223E0200X
General Practice DentistryGroup: 193200000X MULTI-SPECIALTY GROUP 1223G0001X
General Practice DentistryGroup: 193200000X MULTI-SPECIALTY GROUP 1223G0001X 30.017994 OH Primary
Pediatric DentistryGroup: 193200000X MULTI-SPECIALTY GROUP 1223P0221X
PeriodonticsGroup: 193200000X MULTI-SPECIALTY GROUP 1223P0300X
ProsthodonticsGroup: 193200000X MULTI-SPECIALTY GROUP 1223P0700X
Oral and Maxillofacial Surgery (Dentist)Group: 193200000X MULTI-SPECIALTY GROUP 1223S0112X
Orthodontics and Dentofacial Orthopedics DentistryGroup: 193200000X MULTI-SPECIALTY GROUP 1223X0400X

Addresses

Primary practice location

4710 Great Northern Blvd
North Olmsted, OH 44070-3427

Mailing address

PO Box 860036
Minneapolis, MN 55486-0036
Phone (440) 734-6500

Other names 2

  • DentalWorks Doing business as
  • DentalWorks of North Olmsted Doing business as

National Provider Directory

National Provider Directory
Part of
Network Provider Associates

Locations

700 Beta Dr
Ste 500
Mayfield Village, OH 44143
Phone (440) 773-7159

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1139270400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1539907200000",
    "number": "1093787624",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 860036",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554860036",
            "telephone_number": "440-734-6500",
            "fax_number": "216-584-1004"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4710 GREAT NORTHERN BLVD",
            "city": "NORTH OLMSTED",
            "state": "OH",
            "postal_code": "440703427",
            "telephone_number": "440-716-6939",
            "fax_number": "216-584-1004"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MECKLER DENTAL PROVIDERS (OLMSTED), INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "DENTALONE PARTNERS, INC",
        "enumeration_date": "2006-02-07",
        "last_updated": "2018-10-19",
        "status": "A",
        "authorized_official_last_name": "STAUTIHAR",
        "authorized_official_first_name": "KATHLEEN",
        "authorized_official_title_or_position": "SUPERVISOR, CREDENTIALING",
        "authorized_official_telephone_number": "216-584-1673"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1223E0200X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, Endodontics",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "OH",
            "license": "30.017994",
            "primary": true
        },
        {
            "code": "1223P0221X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, Pediatric Dentistry",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1223P0300X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, Periodontics",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1223P0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, Prosthodontics",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1223S0112X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1223X0400X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "DentalWorks",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "DentalWorks of North Olmsted",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in North Olmsted, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 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.