NPIMap

Organization Active NPI

Streetsboro Dental Partners Inc

  • General Practice Dentistry
  • Streetsboro, OH
National Provider Identifier
1649437336
Registry record updated Sep 28, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
20624 Issued in OH
Legal business name
STREETSBORO DENTAL PARTNERS INC
Practice address
1727 Streetsboro PLZ
Streetsboro, OH 44241-5635
Phone
(330) 626-3814
Fax
(330) 626-2169
NPI assigned
May 20, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 28, 2016

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

Authorized official

Name
Lydia Hartman
Title
Credentialing Administrator
Phone
(330) 626-3814

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X 20624 OH Primary

Addresses

Primary practice location

1727 Streetsboro PLZ
Streetsboro, OH 44241-5635

Mailing address

PO Box 2006
1727 Streetsboro Plaza
Streetsboro, OH 44241-0006
Phone (330) 626-3814

Other identifiers 1

IdentifierTypeStateIssuer
2029361MedicaidOH

National Provider Directory

National Provider Directory
Tax ID family
Streetsboro Dental2 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.

Practitioners & affiliated clinicians

Practitioners 10

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": "1211241600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1475020800000",
    "number": "1649437336",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2006",
            "address_2": "1727 STREETSBORO PLAZA",
            "city": "STREETSBORO",
            "state": "OH",
            "postal_code": "442410006",
            "telephone_number": "330-626-3814",
            "fax_number": "330-626-2169"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1727 STREETSBORO PLZ",
            "city": "STREETSBORO",
            "state": "OH",
            "postal_code": "442415635",
            "telephone_number": "330-626-3814",
            "fax_number": "330-626-2169"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STREETSBORO DENTAL PARTNERS INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-05-20",
        "last_updated": "2016-09-28",
        "status": "A",
        "authorized_official_last_name": "HARTMAN",
        "authorized_official_first_name": "LYDIA",
        "authorized_official_title_or_position": "CREDENTIALING ADMINISTRATOR",
        "authorized_official_telephone_number": "330-626-3814"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "OH",
            "license": "20624",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2029361",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Streetsboro, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 28, 2016; 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.