Dynamic Dental Specialists LLC

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

Legal business name

DYNAMIC DENTAL SPECIALISTS LLC

Practice address

583 Wiles Rd
Manfield, OH 44903

Phone

(419) 610-1620

Fax

(419) 756-4886

NPI assigned

Jan 11, 2024

Last updated

Jan 11, 2024By 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

Christopher Norman Beale, DDSNPI 1417155409

Title

President

Phone

(419) 610-1620

Specialties & licenses 1

Addresses

Other identifiers 1

Tax ID family

Dynamic Dental Specialists LLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Dynamic Dental Specialists, LLC

  • Oral and Maxillofacial Surgery (Dentist)
  • Mansfield, OH
  • NPI 1760003891
  NPD tax ID

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Christopher Norman Beale, D.D.S.

  • Oral and Maxillofacial Surgery (Dentist)
  • Camp Lejeune, NC
  • NPI 1417155409
  NPD Authorized official

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

{
    "created_epoch": "1704931200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1704931200000",
    "number": "1194596981",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "583 WILES RD",
            "city": "MANFIELD",
            "state": "OH",
            "postal_code": "44903",
            "telephone_number": "419-610-1620",
            "fax_number": "419-756-4886"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "583 WILES RD",
            "city": "MANFIELD",
            "state": "OH",
            "postal_code": "44903",
            "telephone_number": "419-610-1620",
            "fax_number": "419-756-4886"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DYNAMIC DENTAL SPECIALISTS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-01-11",
        "last_updated": "2024-01-11",
        "status": "A",
        "authorized_official_last_name": "BEALE",
        "authorized_official_first_name": "CHRISTOPHER",
        "authorized_official_middle_name": "NORMAN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "419-610-1620",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0250095",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 11, 2024; 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.