Gregory Ermenc
Individual provider Active NPI General Practice Dentistry · Arcanum, OH
NPI 1205998697 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1205998697
- Entity type
- Individual (NPI type 1)
- Primary specialty
- General Practice Dentistry 1223G0001X
- License
- 30.015043 (OH)
- Practice address
- 1 S High St
Arcanum, OH 45304-1118 - Phone
- (937) 692-5150
- NPI assigned
- Dec 14, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in CA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20150728006218 | CA | Order and Referring Only - Dentist |
6507170032 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 30.015043 | OH | MD | General Practice Dentistry |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Modern Dental Professionals-Lee,Inc | General Practice | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 30.015043 | OH | Yes |
Addresses
Primary practice location
1 S High St
Arcanum, OH 45304-1118
Mailing address
1 S High St
Arcanum, OH 45304-1118
Phone (937) 692-5150
Other providers in Arcanum, OH
- Kelly Bender
- Latrisha Amber Brookey
- Ryan C Cherry
- Carl Curtis
- Sharon Kay Desarro
- Family Health Services of Darke County, Inc.
- Family Health Services of Darke County, Inc.
- Family Health Services of Darke County, Inc.
- Family Health Services of Darke County, Inc.
- Family Health Services of Darke County, Inc.
All providers in Arcanum, OH · General Practice Dentistry in Ohio
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.