Mardis Family Dental, LLC

Primary specialty

DentistTaxonomy code 122300000X

License

30.023452 Issued in OH

Legal business name

MARDIS FAMILY DENTAL, LLC

Practice address

55 S Miller Rd Ste 104
Fairlawn, OH 44333-4167

Phone

(330) 836-7991

Fax

(330) 836-8064

NPI assigned

Sep 1, 2017

Organization subpart

No

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

Authorized official

Name

Mrs. Lisa Marie Mardis

Title

Office Manager

Phone

(330) 836-7991

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

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

{
    "created_epoch": "1504224000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1871011577",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "55 S MILLER RD STE 104",
            "city": "FAIRLAWN",
            "state": "OH",
            "postal_code": "443334167",
            "telephone_number": "330-836-7991",
            "fax_number": "330-836-8064"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "55 S MILLER RD STE 104",
            "city": "FAIRLAWN",
            "state": "OH",
            "postal_code": "443334167",
            "telephone_number": "330-836-7991",
            "fax_number": "330-836-8064"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARDIS FAMILY DENTAL, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-09-01",
        "last_updated": "2022-07-21",
        "status": "A",
        "authorized_official_last_name": "MARDIS",
        "authorized_official_first_name": "LISA",
        "authorized_official_middle_name": "MARIE",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "330-836-7991",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": "OH",
            "license": "30.023452",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1235424227",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Maher Monir Mansour, M.D.
• Pamela Mansour, LPCC
• Roselyn Abalos Manus, M.D.
• Marc Glassman Inc
• Maggie Kristine Marcin, C.N.P.
• Charles Edward Mardis, D.D.S
• Georges Z Markarian, MD
• Kaysie Markland
• Amy Marochino, ATC
• Julianne Amanda Marshall

• Dentist in Fairlawn, OH
• Providers in Fairlawn, OH by specialty
• Dentist in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; 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.