Provider Demographics
NPI:1104061597
Name:CATAWBA DENTAL
Entity type:Organization
Organization Name:CATAWBA DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:HART
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:419-797-2010
Mailing Address - Street 1:3274 NE CATAWBA RD
Mailing Address - Street 2:
Mailing Address - City:PORT CLINTON
Mailing Address - State:OH
Mailing Address - Zip Code:43452-9803
Mailing Address - Country:US
Mailing Address - Phone:419-797-2010
Mailing Address - Fax:
Practice Address - Street 1:3274 NE CATAWBA RD
Practice Address - Street 2:
Practice Address - City:PORT CLINTON
Practice Address - State:OH
Practice Address - Zip Code:43452-9803
Practice Address - Country:US
Practice Address - Phone:419-797-2010
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HART ASSOCAITED HOLDINGS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-12-13
Last Update Date:2008-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30 016070122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty