555 W Elm St Dentistry LLC

NPI #1043351034 in Lima, Ohio

Provider Information

NPI Number: 1043351034
Entity Type: Organization
Organization Name: 555 W Elm St Dentistry LLC
Primary Specialty: Dentist - General Practice
Enumeration Date: Feb 10, 2007
Last Updated: Mar 19, 2008

Practice Location

Address: 555 W ELM ST
City: Lima
State: Ohio
ZIP Code: 45801-4757
Phone: (419) 229-0776

Authorized Official

Name: DAVID WAYNE HANCOCK
Title: OWNER
Phone: (419) 229-0776

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Dentist - General Practice — General Practice	1223G0001X	Primary

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