NPIMap

Organization Active NPI

Ohio Dental Professionals, Delisle, P.C.

Doing business as Advanced Dental Care of Streetsboro

  • General Practice Dentistry
  • Streetsboro, OH
National Provider Identifier
1801387972
Registry record updated Aug 29, 2019
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
Advanced Dental Care of Streetsboro
Practice address
9305 Market Square Dr
Streetsboro, OH 44241-5294
Phone
(330) 422-0011
NPI assigned
May 24, 2018
Organization subpart
Yes
Parent organization
OHIO DENTAL PROFESSIONALS, DELISLE, P.C.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Aug 29, 2019

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

Authorized official

Name
Cassandra Petersen
Title
Credentialing Team Lead
Phone
(217) 540-8972

Specialties & licenses 1

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

Addresses

Primary practice location

9305 Market Square Dr
Streetsboro, OH 44241-5294

Mailing address

9305 Market Square Dr
Streetsboro, OH 44241-5294

Other names 1

  • Advanced Dental Care of Streetsboro Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Heartland Dental Care of Oh Richard E Workman DMD PS39 organizations share this tax ID, including this one
Part of
Heartland Dental Care of Oh Richard E Workman DMD PS

Other organizations with this tax ID 38

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

View all 38

Locations

9305 Market Square Dr
Streetsboro, OH 44241
Phone (330) 422-0011

Practitioners & affiliated clinicians

Practitioners 3

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": "1527120000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1567036800000",
    "number": "1801387972",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9305 MARKET SQUARE DR",
            "city": "STREETSBORO",
            "state": "OH",
            "postal_code": "442415294"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9305 MARKET SQUARE DR",
            "city": "STREETSBORO",
            "state": "OH",
            "postal_code": "442415294",
            "telephone_number": "330-422-0011"
        }
    ],
    "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": "2018-05-24",
        "last_updated": "2019-08-29",
        "status": "A",
        "authorized_official_last_name": "PETERSEN",
        "authorized_official_first_name": "CASSANDRA",
        "authorized_official_title_or_position": "CREDENTIALING TEAM LEAD",
        "authorized_official_telephone_number": "217-540-8972"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Advanced Dental Care of Streetsboro",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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 Aug 29, 2019; 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.