Provider Demographics
NPI:1588873285
Name:CHILDREN'S DENTAL SPECIALISTS OF LAKE COUNTY, DRS. RICHARDS AND MILLER
Entity type:Organization
Organization Name:CHILDREN'S DENTAL SPECIALISTS OF LAKE COUNTY, DRS. RICHARDS AND MILLER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LISA
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:RICHARDS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:440-266-1740
Mailing Address - Street 1:8484 MARKET ST
Mailing Address - Street 2:
Mailing Address - City:MENTOR
Mailing Address - State:OH
Mailing Address - Zip Code:44060-4169
Mailing Address - Country:US
Mailing Address - Phone:440-266-1740
Mailing Address - Fax:440-951-1246
Practice Address - Street 1:8484 MARKET ST
Practice Address - Street 2:
Practice Address - City:MENTOR
Practice Address - State:OH
Practice Address - Zip Code:44060-4169
Practice Address - Country:US
Practice Address - Phone:440-266-1740
Practice Address - Fax:440-266-1746
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-21
Last Update Date:2019-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH184091223P0221X
OH187151223P0221X
OH138401223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Multi-Specialty
Not Answered1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Multi-Specialty