NPIMap

Organization Active NPI

Ohio Dental Professionals, Delisle, P.C.

Doing business as Great Oaks Dental Care

  • General Practice Dentistry
  • Wadsworth, OH
National Provider Identifier
1750900452
Registry record updated Jan 15, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
Legal business name
OHIO DENTAL PROFESSIONALS, DELISLE, P.C.
Doing business as
Great Oaks Dental Care
Practice address
950 High St
Wadsworth, OH 44281-8223
Phone
(330) 331-5738
Fax
(330) 331-7790
NPI assigned
Apr 13, 2020
Last updated
Jan 15, 2021By the provider in NPPES
Organization subpart
Yes
Parent organization
OHIO DENTAL PROFESSIONALS, DELISLE, P.C.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Jan 15, 2021

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

Authorized official

Name
Jessica Britt
Title
Credentialing Coordinator
Phone
(217) 540-5100

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X NU Primary

Addresses

Primary practice location

950 High St
Wadsworth, OH 44281-8223

Mailing address

950 High St
Wadsworth, OH 44281-8223
Phone (330) 331-5738

Other names 1

  • Great Oaks Dental Care Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Heartland Dental Care of Ohiorichard E Workman DMD PC39 organizations share this tax ID, including this one
Part of
Heartland Dental Care of Ohiorichard E Workman DMD PC

Other organizations with this tax ID 38

Organizations that report the same tax identification number in the National Provider Directory.

View all 38

Locations

950 High St
Wadsworth, OH 44281
Phone (330) 331-5738

Practitioners & affiliated clinicians

Practitioners 3

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": "1586736000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1610668800000",
    "number": "1750900452",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "950 HIGH ST",
            "city": "WADSWORTH",
            "state": "OH",
            "postal_code": "442818223",
            "telephone_number": "330-331-5738"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "950 HIGH ST",
            "city": "WADSWORTH",
            "state": "OH",
            "postal_code": "442818223",
            "telephone_number": "330-331-5738",
            "fax_number": "330-331-7790"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OHIO DENTAL PROFESSIONALS, DELISLE, P.C.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "OHIO DENTAL PROFESSIONALS, DELISLE, P.C.",
        "enumeration_date": "2020-04-13",
        "last_updated": "2021-01-15",
        "certification_date": "2021-01-15",
        "status": "A",
        "authorized_official_last_name": "BRITT",
        "authorized_official_first_name": "JESSICA",
        "authorized_official_title_or_position": "CREDENTIALING COORDINATOR",
        "authorized_official_telephone_number": "217-540-5100"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Great Oaks Dental Care",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Great Oaks Dental Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Wadsworth, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 15, 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.