Dental Surgical Center of Medina, Inc

Primary specialty

Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X

License

30022083 Issued in OH

Legal business name

DENTAL SURGICAL CENTER OF MEDINA, INC

Practice address

3613 Reserve Commons Dr
Medina, OH 44256-8179

Phone

(330) 952-1737

NPI assigned

Jan 23, 2010

Organization subpart

No

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

Authorized official

Name

Dr. Steve A H Nguyen, DDS

Title

President

Phone

(330) 952-1737

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in OH

Enrollment records 1

Ambulatory surgical center certification: CCN 36C0001266

Legal name

DENTAL SURGICAL CENTER OF MEDINA

Certification status

Active

Provider type (POS)

Ambulatory surgical center

Participating since

Sep 8, 2011

Last certification

May 3, 2021

Ownership / control type

Proprietary

Facility address

3613 Reserve Commons Drive
Medina, OH 44256

Locations

Practitioners 2

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

• Anh-Steve Huy Nguyen, D.D.S

  • Dental Anesthesiology
  • Medina, OH
  • NPI 1033179692
  NPD
• Tikhon Kim, MD

  • Anesthesiology Physician
  • Cleveland, OH
  • NPI 1265490478
  NPD (past)

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

{
    "created_epoch": "1264204800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1591315200000",
    "number": "1861723322",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3613 RESERVE COMMONS DR",
            "city": "MEDINA",
            "state": "OH",
            "postal_code": "442568179",
            "telephone_number": "330-952-1737"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3613 RESERVE COMMONS DR",
            "city": "MEDINA",
            "state": "OH",
            "postal_code": "442568179",
            "telephone_number": "330-952-1737"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DENTAL SURGICAL CENTER OF MEDINA, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-01-23",
        "last_updated": "2020-06-05",
        "certification_date": "2020-06-05",
        "status": "A",
        "authorized_official_last_name": "NGUYEN",
        "authorized_official_first_name": "STEVE",
        "authorized_official_middle_name": "A H",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "330-952-1737",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "OH",
            "license": "30022083",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Janice Ann Demyan, LPN
• Denis J Slaby MD Inc
• Gina Dennis
• Dental Express Medina -Jerry S. Kolosionek DDS LLC
• Dental Professionals Cleveland - Nouneh, Inc.
• Alice M Denton, M.D.
• Stephen Douglas Depp
• Tammy Depriest
• Kathleen Ellen Derga, MACCC/SLP
• Kriszti R Derga

• Ambulatory Surgical Clinic/Center in Medina, OH
• Providers in Medina, OH by specialty
• Ambulatory Surgical Clinic/Center in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 5, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.