| NPI | 1699236059 |
|---|---|
| Doing Business As | NORTHSIDE DENTAL CENTER |
| Entity Type | Organization |
| Authorized Contact | RONALD DWINNELLS CEO 330-747-9551 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery |
| 124Q00000X Dental Hygienist | |
| 122300000X Dentist | |
| 1223G0001X Dentist, General Practice | |
| Enumeration Date | 2019-03-28 |
| Last Update Date | 2019-03-28 |