Provider Demographics
NPI:1730428830
Name:CANTON FAMILY DENTISTRY
Entity type:Organization
Organization Name:CANTON FAMILY DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KANTHASAMY
Authorized Official - Middle Name:
Authorized Official - Last Name:RAGUNANTHAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MS
Authorized Official - Phone:330-453-8787
Mailing Address - Street 1:603 13TH ST NW
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44703-3121
Mailing Address - Country:US
Mailing Address - Phone:330-453-8787
Mailing Address - Fax:330-453-9292
Practice Address - Street 1:603 13TH ST NW
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44703-3121
Practice Address - Country:US
Practice Address - Phone:330-453-8787
Practice Address - Fax:330-453-9292
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-08
Last Update Date:2013-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH191471223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty