Provider Demographics
NPI:1104138262
Name:DENTAL EXPRESS KENT LAURA B WILLIAMS DMD LLC
Entity type:Organization
Organization Name:DENTAL EXPRESS KENT LAURA B WILLIAMS DMD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:B
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:330-678-3990
Mailing Address - Street 1:3800 BOARDMAN CANFIELD RD
Mailing Address - Street 2:
Mailing Address - City:CANFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44406-9029
Mailing Address - Country:US
Mailing Address - Phone:330-533-3400
Mailing Address - Fax:330-533-2700
Practice Address - Street 1:1951 STATE ROUTE 59
Practice Address - Street 2:SUITE B
Practice Address - City:KENT
Practice Address - State:OH
Practice Address - Zip Code:44240-8128
Practice Address - Country:US
Practice Address - Phone:330-678-3990
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-06
Last Update Date:2010-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30-0231611223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty