Provider Demographics
NPI:1548473168
Name:WEDGEWOOD DENTAL ASSOCIATES INC.
Entity type:Organization
Organization Name:WEDGEWOOD DENTAL ASSOCIATES INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NORMAN
Authorized Official - Middle Name:
Authorized Official - Last Name:STRAKER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:614-792-0063
Mailing Address - Street 1:10401 SAWMILL PKWY STE 100-D
Mailing Address - Street 2:
Mailing Address - City:POWELL
Mailing Address - State:OH
Mailing Address - Zip Code:43065-8423
Mailing Address - Country:US
Mailing Address - Phone:614-792-0063
Mailing Address - Fax:614-792-3376
Practice Address - Street 1:10401 SAWMILL PKWY STE 100-D
Practice Address - Street 2:
Practice Address - City:POWELL
Practice Address - State:OH
Practice Address - Zip Code:43065-8423
Practice Address - Country:US
Practice Address - Phone:614-792-0063
Practice Address - Fax:614-792-3376
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH155471223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty