Provider Demographics
NPI:1588757470
Name:SOUTH COURT DENTAL MEDICINE, INC. -JEFFREY C ESTERBURG D.M.D. AND MICH
Entity type:Organization
Organization Name:SOUTH COURT DENTAL MEDICINE, INC. -JEFFREY C ESTERBURG D.M.D. AND MICH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:C
Authorized Official - Last Name:ESTERBURG
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:330-725-0581
Mailing Address - Street 1:1063 S COURT ST
Mailing Address - Street 2:
Mailing Address - City:MEDINA
Mailing Address - State:OH
Mailing Address - Zip Code:44256-2824
Mailing Address - Country:US
Mailing Address - Phone:330-725-0581
Mailing Address - Fax:330-722-0146
Practice Address - Street 1:1063 S COURT ST
Practice Address - Street 2:
Practice Address - City:MEDINA
Practice Address - State:OH
Practice Address - Zip Code:44256-2824
Practice Address - Country:US
Practice Address - Phone:330-725-0581
Practice Address - Fax:330-722-0146
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty