Sedon Dental Providers (medina), Inc.

NPI #1104019587 in Medina, Ohio

Provider Information

NPI Number: 1104019587
Entity Type: Organization
Organization Name: Sedon Dental Providers (medina), Inc.
Subpart: Yes (part of a larger organization)
Parent Organization: DENTALONE PARTNERS, INC
Primary Specialty: Dentist
Enumeration Date: Aug 20, 2007
Last Updated: Oct 16, 2017

Practice Location

Address: 5014 GRANDE SHOPS AVE
City: Medina
State: Ohio
ZIP Code: 44256
Phone: (330) 764-9290

Authorized Official

Name: RACHEL NITTINGER
Title: MANAGER CREDENTIALING
Phone: (972) 755-0816

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Dentist - General Practice — General Practice	1223G0001X
Dentist - Pediatric Dentistry — Pediatric Dentistry	1223P0221X
Dentist - Periodontics — Periodontics	1223P0300X
Dentist - Prosthodontics — Prosthodontics	1223P0700X
Dentist - Orthodontics and Dentofacial Orthopedics — Orthodontics and Dentofacial Orthopedics	1223X0400X
Dentist	122300000X	Primary

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