NPIMap

Organization Active NPI

Dental Express Boardman, Ted a Schuster DDS LLC

  • Dentist
  • Boardman, OH
National Provider Identifier
1962730549
Registry record updated Jul 20, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
30020654 Issued in OH
Legal business name
DENTAL EXPRESS BOARDMAN, TED A SCHUSTER DDS LLC
Practice address
6540 South Ave
Boardman, OH 44512-3651
Phone
(330) 533-3400
NPI assigned
Nov 19, 2009
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 20, 2010

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

Authorized official

Name
Amy R Mauerman
Title
Administrative Director
Phone
(330) 533-3400

Specialties & licenses 7

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 122300000X 30022311 OH
DentistGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 122300000X 30015046 OH
DentistGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 122300000X 30020654 OH Primary
DentistGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 122300000X 30-012873 OH
DentistGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 122300000X 30-01955 OH
DentistGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 122300000X 30-022882 OH
DentistGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 122300000X 30-023087 OH

Addresses

Primary practice location

6540 South Ave
Boardman, OH 44512-3651

Mailing address

6540 South Ave
Boardman, OH 44512-3651
Phone (330) 533-3400

Other identifiers 3

IdentifierTypeStateIssuer
2966992MedicaidOH
0296166MedicaidOH
2994578MedicaidOH

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1258588800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1279584000000",
    "number": "1962730549",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6540 SOUTH AVE",
            "city": "BOARDMAN",
            "state": "OH",
            "postal_code": "445123651",
            "telephone_number": "330-533-3400"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6540 SOUTH AVE",
            "city": "BOARDMAN",
            "state": "OH",
            "postal_code": "445123651",
            "telephone_number": "330-533-3400"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DENTAL EXPRESS BOARDMAN, TED A SCHUSTER DDS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-11-19",
        "last_updated": "2010-07-20",
        "status": "A",
        "authorized_official_last_name": "MAUERMAN",
        "authorized_official_first_name": "AMY",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "ADMINISTRATIVE DIRECTOR",
        "authorized_official_telephone_number": "330-533-3400"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist",
            "state": "OH",
            "license": "30022311",
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist",
            "state": "OH",
            "license": "30015046",
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist",
            "state": "OH",
            "license": "30020654",
            "primary": true
        },
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist",
            "state": "OH",
            "license": "30-012873",
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist",
            "state": "OH",
            "license": "30-01955",
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist",
            "state": "OH",
            "license": "30-022882",
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist",
            "state": "OH",
            "license": "30-023087",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2966992",
            "state": "OH"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0296166",
            "state": "OH"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2994578",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Boardman, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 20, 2010; 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.