NPIMap

Organization Active NPI

Third Street Community Clinic, Inc.

Doing business as 9th Street Dental Center

  • Federally Qualified Health Center (FQHC)
  • Ashland, OH
National Provider Identifier
1710517339
Registry record updated May 19, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
THIRD STREET COMMUNITY CLINIC, INC.
Doing business as
9th Street Dental Center
Practice address
431 E 9TH St
Ashland, OH 44805-1903
Phone
(419) 289-1430
Fax
(419) 525-6723
NPI assigned
Jan 23, 2020
Last updated
May 19, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 19, 2026

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

Authorized official

Name
Peggy Anderson
Title
Ceo
Phone
(419) 526-7880

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193200000X MULTI-SPECIALTY GROUP 1223G0001X
Federally Qualified Health Center (FQHC) 261QF0400X Primary

Addresses

Primary practice location

431 E 9TH St
Ashland, OH 44805-1903

Mailing address

1404 Park Ave W Ste 2
Ontario, OH 44906-2719
Phone (419) 522-6191

Other names 1

  • 9th Street Dental Center Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20201022001123 OH Part A Provider - Federally Qualified Health Center (FQHC) 2365423977 Practice locations: Ashland, OH
O20260410003485 OH Part B Supplier - Clinic/Group Practice 2365423977 Practice locations: Ashland, OH

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1710517339. Details of each certification follow.

Federally qualified health center certification: CCN 721862

Legal name
THIRD STREET COMMUNITY CLINIC, INC.
Doing business as
9TH STREET DENTAL CENTER
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Oct 22, 2020
Last certification
Oct 22, 2020
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Dec 3, 1993 in OH
Enrollment address
431 E 9TH St
Ashland, OH 44805-1903

Other NPIs with the same Medicare PAC ID 12

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory

Locations

431 E 9th St
Ashland, OH 44805
Phone (419) 289-1430

Ownership & related parties

All disclosed owners & managing parties 12

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
James Dolan Individual Corporate DirectorBoard Member Jul 7, 2020
Dorothy Stratton Individual Corporate DirectorBoard Member Jul 7, 2020
Allen Hocker Individual Corporate DirectorBoard Member May 18, 2023
Douglas Newsome Individual Corporate DirectorBoard Member May 18, 2023
Jalen Reese Individual Corporate DirectorBoard Member May 18, 2023
Brigitte Coles Individual Corporate DirectorBoard Member Oct 19, 2021
Kathy Wells Individual Corporate DirectorBoard Member Oct 19, 2023
Khushwant Pittenger Individual Corporate DirectorBoard Member Jul 7, 2020
Amber Wertman Individual Corporate DirectorBoard Member Jul 7, 2020
Peggy S Anderson Individual Corporate OfficerCeo Jul 27, 2021
Corporate DirectorBoard Member - P Jul 27, 2021
W-2 Managing EmployeeCeo Jul 27, 2021
Barrett Thomas Individual Corporate DirectorTreasurer Feb 16, 2023
Sally Gesouras Individual Corporate DirectorBoard Member Jan 18, 2024

Practitioners & affiliated clinicians

Practitioners 4

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": "1579737600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1779148800000",
    "number": "1710517339",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1404 PARK AVE W STE 2",
            "city": "ONTARIO",
            "state": "OH",
            "postal_code": "449062719",
            "telephone_number": "419-522-6191",
            "fax_number": "419-525-6723"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "431 E 9TH ST",
            "city": "ASHLAND",
            "state": "OH",
            "postal_code": "448051903",
            "telephone_number": "419-289-1430",
            "fax_number": "419-525-6723"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THIRD STREET COMMUNITY CLINIC, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-01-23",
        "last_updated": "2026-05-19",
        "certification_date": "2026-05-19",
        "status": "A",
        "authorized_official_last_name": "ANDERSON",
        "authorized_official_first_name": "PEGGY",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "419-526-7880"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "9th Street Dental Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "9th Street Dental Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Ashland, OH

Sources for this page

Verify at the official NPI Registry.