Provider Demographics
NPI:1386144707
Name:LORAIN FAMILY DENTAL
Entity type:Organization
Organization Name:LORAIN FAMILY DENTAL
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DENTIST OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAMAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SIMANTIRIS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:440-434-2990
Mailing Address - Street 1:4466 DORAL DR
Mailing Address - Street 2:
Mailing Address - City:AVON
Mailing Address - State:OH
Mailing Address - Zip Code:44011-3744
Mailing Address - Country:US
Mailing Address - Phone:440-655-0045
Mailing Address - Fax:
Practice Address - Street 1:4560 OBERLIN AVE
Practice Address - Street 2:
Practice Address - City:LORAIN
Practice Address - State:OH
Practice Address - Zip Code:44053-3195
Practice Address - Country:US
Practice Address - Phone:440-434-2990
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-13
Last Update Date:2018-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty