Provider Demographics
NPI:1194972273
Name:ASPEN DENTAL
Entity type:Organization
Organization Name:ASPEN DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGIONAL MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:STELLA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:315-440-8203
Mailing Address - Street 1:15500 VAN AKEN BLVD
Mailing Address - Street 2:APT 205
Mailing Address - City:SHAKER HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44120-5390
Mailing Address - Country:US
Mailing Address - Phone:216-751-8767
Mailing Address - Fax:216-661-8022
Practice Address - Street 1:15500 VAN AKEN BLVD
Practice Address - Street 2:APT 205
Practice Address - City:SHAKER HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44120-5390
Practice Address - Country:US
Practice Address - Phone:216-751-8767
Practice Address - Fax:216-661-8022
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-20
Last Update Date:2008-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30.0228711223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty