Leidenheimer Dental Group, Inc.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

30020876 Issued in OH

Legal business name

LEIDENHEIMER DENTAL GROUP, INC.

Practice address

42707 N Ridge Rd
Elyria, OH 44035-1054

Phone

(440) 444-0379

Fax

(440) 654-2778

NPI assigned

Mar 10, 2008

Organization subpart

No

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

Authorized official

Name

Mrs. Jennifer A Sochacki

Title

Office Manager/Treasurer

Phone

(440) 444-0379

Specialties & licenses 1

Addresses

Other identifiers 6

Other names 1

• James L. Matz DDS, Inc. Former legal business name

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.

• Leidenheimer Dental Group

  • Specialist
  • Elyria, OH
  • NPI 1639454804
  NPD tax ID

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Kacy Bielozer, DDS

  • Dentist
  • Elyria, OH
  • NPI 1225440001
  NPD (past)
• Santoshiratnam Kedarsetty, DMD

  • General Practice Dentistry
  • Elyria, OH
  • NPI 1427407840
  NPD (past)
• Joseph M. Liszeski, D.M.D.

  • General Practice Dentistry
  • Elyria, OH
  • NPI 1356475917
  NPD (past)
• Louis Ronald Smith, DDS

  • Dentist
  • Elyria, OH
  • NPI 1841274859
  NPD (past)

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

{
    "created_epoch": "1205107200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1433203200000",
    "number": "1750551479",
    "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": "440-444-0379",
            "fax_number": "440-654-2778"
        },
        {
            "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": "440-444-0379",
            "fax_number": "440-654-2778"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LEIDENHEIMER DENTAL GROUP, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-03-10",
        "last_updated": "2015-06-02",
        "status": "A",
        "authorized_official_last_name": "SOCHACKI",
        "authorized_official_first_name": "JENNIFER",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "OFFICE MANAGER/TREASURER",
        "authorized_official_telephone_number": "440-444-0379",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "OH",
            "license": "30020876",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2825410",
            "state": "OH"
        },
        {
            "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": "2203538",
            "state": "OH"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3107033",
            "state": "OH"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4614975",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "James L. Matz DDS, Inc.",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

• Krista Ledwell
• Lisa Lynne Lee, R.N.
• Melanie Cohen Lee, LPN
• Seotack Lee, DDS
• Leidenheimer Dental Group
• Joyce Ann Lender, M.D.
• Caryn Leon
• Soledad Justine Leos
• Tamlyn Marie Leroux, LPN
• Batina Lesco

• General Practice Dentistry in Elyria, OH
• Providers in Elyria, OH by specialty
• General Practice Dentistry in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 2, 2015; 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.