Provider Demographics
NPI:1104059658
Name:CASE DENTAL MEDICINE SUPPORT SERVICES, LLC.
Entity type:Organization
Organization Name:CASE DENTAL MEDICINE SUPPORT SERVICES, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DEPARTMENT CHAIR
Authorized Official - Prefix:MR
Authorized Official - First Name:DALE
Authorized Official - Middle Name:A
Authorized Official - Last Name:BAUR
Authorized Official - Suffix:SR
Authorized Official - Credentials:DDS
Authorized Official - Phone:216-368-3102
Mailing Address - Street 1:P.O. BOX 415
Mailing Address - Street 2:
Mailing Address - City:CHESTERLAND
Mailing Address - State:OH
Mailing Address - Zip Code:44026-0415
Mailing Address - Country:US
Mailing Address - Phone:440-729-3399
Mailing Address - Fax:440-729-6001
Practice Address - Street 1:9601 CHESTER AVE
Practice Address - Street 2:SUITE 154
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44106-1666
Practice Address - Country:US
Practice Address - Phone:216-368-3102
Practice Address - Fax:216-368-4338
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-01
Last Update Date:2021-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH301960Medicaid