Provider Demographics
NPI:1538186390
Name:MICHAEL M. MOTT D.D.S., LTD.
Entity type:Organization
Organization Name:MICHAEL M. MOTT D.D.S., LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:MARTIN
Authorized Official - Last Name:MOTT
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:419-399-3394
Mailing Address - Street 1:PO BOX 359
Mailing Address - Street 2:
Mailing Address - City:PAULDING
Mailing Address - State:OH
Mailing Address - Zip Code:45879-0359
Mailing Address - Country:US
Mailing Address - Phone:419-399-3394
Mailing Address - Fax:
Practice Address - Street 1:402 E BALDWIN AVE
Practice Address - Street 2:
Practice Address - City:PAULDING
Practice Address - State:OH
Practice Address - Zip Code:45879-1107
Practice Address - Country:US
Practice Address - Phone:419-399-3394
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH300176781223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0801725Medicaid