Spa Creek Dental of Oh LLC

Primary specialty

DentistTaxonomy code 122300000X

Legal business name

SPA CREEK DENTAL OF OH LLC

Practice address

5547 Mahoning Ave
Austintown, OH 44515-2316

Phone

(267) 691-2800

Fax

(267) 691-2830

NPI assigned

Aug 10, 2021

Organization subpart

No

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

Authorized official

Name

Amber Lloyd

Title

Accounts Receivable Specialist

Phone

(267) 691-2812

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1628553600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1628640000000",
    "number": "1639844939",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "626 JACKSONVILLE RD STE 101",
            "city": "WARMINSTER",
            "state": "PA",
            "postal_code": "189744861",
            "telephone_number": "267-691-2800",
            "fax_number": "267-691-2812"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5547 MAHONING AVE",
            "city": "AUSTINTOWN",
            "state": "OH",
            "postal_code": "445152316",
            "telephone_number": "267-691-2800",
            "fax_number": "267-691-2830"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SPA CREEK DENTAL OF OH LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-08-10",
        "last_updated": "2021-08-11",
        "certification_date": "2021-08-11",
        "status": "A",
        "authorized_official_last_name": "LLOYD",
        "authorized_official_first_name": "AMBER",
        "authorized_official_title_or_position": "ACCOUNTS RECEIVABLE SPECIALIST",
        "authorized_official_telephone_number": "267-691-2812"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 11, 2021; 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.