NPIMap

Organization Active NPI

Ohio Dental Professionals, Delisle, P.C.

  • General Practice Dentistry
  • Lakewood, OH
National Provider Identifier
1255049110
Registry record updated Mar 23, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
Legal business name
OHIO DENTAL PROFESSIONALS, DELISLE, P.C.
Practice address
13616 Madison Ave
Lakewood, OH 44107-4709
Phone
(216) 221-1438
NPI assigned
Nov 9, 2022
Organization subpart
Yes
Parent organization
OHIO DENTAL PROFESSIONALS, DELISLE, P.C.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Mar 23, 2023

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

Authorized official

Name
Courtney Monteith
Title
Credentialing Coordinator
Phone
(217) 540-8306

Specialties & licenses 1

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

Addresses

Primary practice location

13616 Madison Ave
Lakewood, OH 44107-4709

Mailing address

13616 Madison Ave
Lakewood, OH 44107-4709

Other names 1

  • Peak Dental of Lakewood Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Heartland Dental Care of Oh Richard E Workman DMD PS39 organizations share this tax ID, including this one
Part of
Heartland Dental Care of Oh Richard E Workman DMD PS

Other organizations with this tax ID 38

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

View all 38

Locations

13616 Madison Ave
Lakewood, OH 44107
Phone (216) 221-1438

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": "1667952000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1679529600000",
    "number": "1255049110",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13616 MADISON AVE",
            "city": "LAKEWOOD",
            "state": "OH",
            "postal_code": "441074709"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13616 MADISON AVE",
            "city": "LAKEWOOD",
            "state": "OH",
            "postal_code": "441074709",
            "telephone_number": "216-221-1438"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OHIO DENTAL PROFESSIONALS, DELISLE, P.C.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "OHIO DENTAL PROFESSIONALS, DELISLE, P.C.",
        "enumeration_date": "2022-11-09",
        "last_updated": "2023-03-23",
        "certification_date": "2023-03-23",
        "status": "A",
        "authorized_official_last_name": "MONTEITH",
        "authorized_official_first_name": "COURTNEY",
        "authorized_official_title_or_position": "CREDENTIALING COORDINATOR",
        "authorized_official_telephone_number": "217-540-8306"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Peak Dental of Lakewood",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Lakewood, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 23, 2023; 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.