NPIMap

Organization Active NPI

Mogadore Family Dentistry

  • Dentist
  • Mogadore, OH
National Provider Identifier
1972624922
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
30.018523 Issued in OH
Legal business name
MOGADORE FAMILY DENTISTRY
Practice address
11 S Cleveland Ave
Mogadore, OH 44260-1514
Phone
(330) 628-3017
Fax
(330) 628-1436
NPI assigned
Apr 3, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Louis W Konstan, D.D.S.NPI 1922216852
Title
Dentist
Phone
(330) 628-3017

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193400000X SINGLE SPECIALTY GROUP 122300000X 30.018523 OH Primary

Addresses

Primary practice location

11 S Cleveland Ave
Mogadore, OH 44260-1514

Mailing address

11 S Cleveland Ave
Mogadore, OH 44260-1514
Phone (330) 628-3017

National Provider Directory

National Provider Directory

Locations

11 S Cleveland Ave
Mogadore, OH 44260
Phone (330) 628-3017

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": "1175558400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1972624922",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11 S CLEVELAND AVE",
            "city": "MOGADORE",
            "state": "OH",
            "postal_code": "442601514",
            "telephone_number": "330-628-3017",
            "fax_number": "330-628-1436"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11 S CLEVELAND AVE",
            "city": "MOGADORE",
            "state": "OH",
            "postal_code": "442601514",
            "telephone_number": "330-628-3017",
            "fax_number": "330-628-1436"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MOGADORE FAMILY DENTISTRY",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-03",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "KONSTAN",
        "authorized_official_first_name": "LOUIS",
        "authorized_official_middle_name": "W",
        "authorized_official_title_or_position": "DENTIST",
        "authorized_official_telephone_number": "330-628-3017",
        "authorized_official_credential": "D.D.S."
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": "OH",
            "license": "30.018523",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Mogadore, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 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.