NPIMap

Organization Active NPI

Leidenheimer Dental Group

  • Specialist
  • Elyria, OH
National Provider Identifier
1639454804
Registry record updated Jan 26, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
Legal business name
LEIDENHEIMER DENTAL GROUP
Practice address
42707 N Ridge Rd
Elyria, OH 44035-1054
Phone
(440) 324-3441
NPI assigned
Oct 19, 2011
Last updated
Jan 26, 2012By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 26, 2012

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

Authorized official

Name
Mrs. Jennifer Ann Sochacki
Title
Manager
Phone
(440) 324-3441

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Specialist 174400000X NU Primary

Addresses

Primary practice location

42707 N Ridge Rd
Elyria, OH 44035-1054

Mailing address

42707 N Ridge Rd
Elyria, OH 44035-1054
Phone (440) 324-3441

Other identifiers 4

IdentifierTypeStateIssuer
0015325MedicaidOH
2093907MedicaidOH
2825410MedicaidOH
2203538MedicaidOH

National Provider Directory

National Provider Directory
Tax ID family
James L Matz DDS Inc2 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.

Locations

42707 N Ridge Rd
Elyria, OH 44035
Phone (440) 324-3441

Practitioners & affiliated clinicians

Practitioners 7

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.

NPI Registry JSON

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

{
    "created_epoch": "1318982400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1327536000000",
    "number": "1639454804",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "42707 N RIDGE RD",
            "city": "ELYRIA",
            "state": "OH",
            "postal_code": "440351054",
            "telephone_number": "440-324-3441"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "42707 N RIDGE RD",
            "city": "ELYRIA",
            "state": "OH",
            "postal_code": "440351054",
            "telephone_number": "440-324-3441"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LEIDENHEIMER DENTAL GROUP",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-10-19",
        "last_updated": "2012-01-26",
        "status": "A",
        "authorized_official_last_name": "SOCHACKI",
        "authorized_official_first_name": "JENNIFER",
        "authorized_official_middle_name": "ANN",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "440-324-3441",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0015325",
            "state": "OH"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2093907",
            "state": "OH"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2825410",
            "state": "OH"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2203538",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Elyria, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 26, 2012; 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.