Provider Demographics
NPI:1700960754
Name:NORTH COAST FAMILY DENTAL CARE INC.
Entity type:Organization
Organization Name:NORTH COAST FAMILY DENTAL CARE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:JACK
Authorized Official - Middle Name:W
Authorized Official - Last Name:THOMASON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:440-212-4949
Mailing Address - Street 1:20886 DRAKE RD
Mailing Address - Street 2:
Mailing Address - City:STRONGSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44149-5850
Mailing Address - Country:US
Mailing Address - Phone:440-572-5055
Mailing Address - Fax:440-572-6020
Practice Address - Street 1:20886 DRAKE RD
Practice Address - Street 2:
Practice Address - City:STRONGSVILLE
Practice Address - State:OH
Practice Address - Zip Code:44149-5850
Practice Address - Country:US
Practice Address - Phone:440-572-5055
Practice Address - Fax:440-572-6020
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30021111122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty