Provider Demographics
NPI:1063710010
Name:CANTON PEDIATRIC DENTAL CENTER
Entity type:Organization
Organization Name:CANTON PEDIATRIC DENTAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PEDIATRIC DENTIST/MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:SAFURATU
Authorized Official - Middle Name:YETUNDE
Authorized Official - Last Name:ARANMOLATE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:216-926-8181
Mailing Address - Street 1:1455 HARRISON AVE NW
Mailing Address - Street 2:SUITE 200
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44708-2621
Mailing Address - Country:US
Mailing Address - Phone:330-994-0205
Mailing Address - Fax:330-994-0207
Practice Address - Street 1:3934 EVERHARD RD NW
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44709-4005
Practice Address - Country:US
Practice Address - Phone:330-994-0205
Practice Address - Fax:330-994-0207
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-28
Last Update Date:2024-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH219811223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH1104816016OtherNPI