Dynamic Dental Specialists, LLC

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

Legal business name

DYNAMIC DENTAL SPECIALISTS, LLC

Practice address

630 Lexington Ave
Mansfield, OH 44907-1500

Phone

(419) 756-0711

NPI assigned

Apr 29, 2020

Last updated

Apr 29, 2020By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Christopher Beale, DDSNPI 1417155409

Title

President

Phone

(248) 346-4809

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Dynamic Dental Specialists, LLC Other name

Electronic endpoints 1

Tax ID family

Dynamic Dental Specialists LLC2 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.

• Dynamic Dental Specialists LLC

  • Oral and Maxillofacial Surgery (Dentist)
  • Manfield, OH
  • NPI 1194596981
  NPD tax ID

Practitioners 1

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.

• Christopher Norman Beale, D.D.S.

  • Oral and Maxillofacial Surgery (Dentist)
  • Camp Lejeune, NC
  • NPI 1417155409
  NPD Authorized official

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

{
    "created_epoch": "1588118400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1588118400000",
    "number": "1760003891",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1535 PINE GROVE CT",
            "city": "MANSFIELD",
            "state": "OH",
            "postal_code": "449063519"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "630 LEXINGTON AVE",
            "city": "MANSFIELD",
            "state": "OH",
            "postal_code": "449071500",
            "telephone_number": "419-756-0711"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DYNAMIC DENTAL SPECIALISTS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-04-29",
        "last_updated": "2020-04-29",
        "certification_date": "2020-04-29",
        "status": "A",
        "authorized_official_last_name": "BEALE",
        "authorized_official_first_name": "CHRISTOPHER",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "248-346-4809",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0250095",
            "state": "OH"
        }
    ],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "oakwoodoralsurgery@gmail.com",
            "affiliation": "N",
            "address_1": "630 Lexington Ave",
            "city": "Mansfield",
            "state": "OH",
            "country_code": "US",
            "postal_code": "449071500",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Dynamic Dental Specialists, LLC",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Tricia Durham, ATS, CDCA
• Lauren Durinka, AU.D.
• Anna Marie Durtschi, RN
• Cassi Faye Dye, LISW
• Nicole Rae Dyer, CNP
• Ear Nose Throat Head & Neck Surgeons of NE Ohio Inc
• Kathleen A Earle, PT
• Tarasha Eatmon
• Amy Eaton, RN
• Gregory M. Eaton, M.D.

• Oral and Maxillofacial Surgery (Dentist) in Mansfield, OH
• Providers in Mansfield, OH by specialty
• Oral and Maxillofacial Surgery (Dentist) in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 29, 2020; 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.