NPIMap

Organization Active NPI

City Wide Dental Services

  • General Practice Dentistry
  • Toledo, OH
National Provider Identifier
1164530259
Registry record updated Oct 2, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
17029 Issued in OH
Legal business name
CITY WIDE DENTAL SERVICES
Practice address
725 Miami St
Toledo, OH 43605-2278
Phone
(419) 693-4712
Fax
(419) 693-4495
NPI assigned
Aug 28, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 2, 2007

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

Authorized official

Name
Mark Joseph Heenan, DMDNPI 1356459671
Title
President
Phone
(419) 693-4712

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X 17029 OH Primary

Addresses

Primary practice location

725 Miami St
Toledo, OH 43605-2278

Mailing address

725 Miami St
Toledo, OH 43605-2278
Phone (419) 693-4712

Other identifiers 2

IdentifierTypeStateIssuer
04944OtherOHPARAMOUNT
2618984MedicaidOH

National Provider Directory

National Provider Directory

Locations

725 Miami St
Toledo, OH 43605
Phone (419) 693-4712

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": "1156723200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1191283200000",
    "number": "1164530259",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "725 MIAMI ST",
            "city": "TOLEDO",
            "state": "OH",
            "postal_code": "436052278",
            "telephone_number": "419-693-4712",
            "fax_number": "419-693-4495"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "725 MIAMI ST",
            "city": "TOLEDO",
            "state": "OH",
            "postal_code": "436052278",
            "telephone_number": "419-693-4712",
            "fax_number": "419-693-4495"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CITY WIDE DENTAL SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-28",
        "last_updated": "2007-10-02",
        "status": "A",
        "authorized_official_last_name": "HEENAN",
        "authorized_official_first_name": "MARK",
        "authorized_official_middle_name": "JOSEPH",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "419-693-4712",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "OH",
            "license": "17029",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PARAMOUNT",
            "identifier": "04944",
            "state": "OH"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2618984",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Toledo, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 2, 2007; 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.