PORTAGE DENTAL CENTER (NPI# 1316093024) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1316093024 |
| Entity Type | Organization |
| Organization Name | PORTAGE DENTAL CENTER |
| Practice Address |
250 S Chestnut St Ste 30 Ravenna OH 44266-3031 |
| Practice Telephone | 3302977009 |
| Practice Fax Number | 3302970901 |
| Mailing Telephone | 3302977009 |
| Mailing Fax Number | 3302970901 |
| Enumeration Date | 2007-01-26 |
| Last Update Date | 2014-02-19 |
| Authorized Official Name | MS. ANN HARRY (OFFICE ADMINISTRATOR MGR) |
| Authorized Official Telephone | 3302977009 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 1223G0001X |
Dentist Specialization: General Practice |
Dental Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| OH | 0468597 | 05 |
| Street Address |
250 S CHESTNUT ST STE 30 |
| City | RAVENNA |
| State | OH |
| Zip Code | 44266-3031 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1518583608 | Portage Dental Group, Jeffrey S. Rosenthal D.d.s., Inc. | Clinic/Center | 250 S Chestnut St Ste 30, Ravenna, OH 44266-3031 | 2020-06-24 |
| 1740842251 | Tonya Marie Frys | Dentist | 250 S Chestnut St Ste 30, Ravenna, OH 44266-3031 | 2019-07-03 |
| 1366898249 | Richard Hall | Dentist | 250 S Chestnut St Ste 30, Ravenna, OH 44266-3031 | 2016-05-10 |
| 1689018608 | Sandon Scott Wiedemann | Dentist | 250 S Chestnut St Ste 30, Ravenna, OH 44266-3031 | 2013-04-21 |
| 1851437057 | Andrew Jason Cook | Dentist | 250 S Chestnut St Ste 30, Ravenna, OH 44266-3031 | 2007-01-29 |
| 1598811283 | David Alan Rosenberg | Dentist | 250 S Chestnut St Ste 30, Ravenna, OH 44266-3031 | 2007-01-26 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1407409501 | Jeffrey Michael Jones | Hearing Instrument Specialist | 131 E. Hain St Beltone Hearing Care Center, Ravenna, OH 44266 | 2019-07-18 |
| 1285286443 | Robert Ailes Lax | Counselor | 246 S. Chestnut St., Ravenna, OH 44266 | 2019-07-09 |
| 1841792314 | Jason Troyer | Case Manager/Care Coordinator | 3920 Lover's Lane, Ravenna, OH 44266 | 2018-03-01 |
| 1316446370 | Jacquelin Grace Claren | Case Manager/Care Coordinator | 3920 Lovers Lane, Ravenna, OH 44266 | 2018-02-06 |
| 1164921318 | Tammy M Morris | Counselor | 4771 Washington Ave., Ravenna, OH 44266 | 2018-02-02 |
| 1306360219 | Megan Kathryn Marsh | Nurse Practitioner | 3215 Menough Rd, Ravenna, OH 44266 | 2017-08-01 |
| 1063875110 | Mary Kathryn Revello | Home Health Aide | 103 N.scycamore St, Ravenna 44266, OH 44266 | 2016-04-05 |
| 1396114302 | Theresa Brooks Kotlar | Registered Nurse | 7174 Colonial Place, Ravenna, OH 44266 | 2015-09-20 |
| 1811384118 | Okap Kwon Md Inc | Internal Medicine | 964 East Main Street, Ravenna, OH 44266 | 2015-04-24 |
| 1104223783 | Julie Winkler | Speech-Language Pathologist | 639 W. Main St, Ravenna, OH 44266 | 2014-11-26 |
| Find all providers in zip 44266 | ||||
| Taxonomy Code | 1223G0001X |
| Grouping | Dental Providers |
| Classification | Dentist |
| Specialization | General Practice |
| A general dentist is the primary dental care provider for patients of all ages. The general dentist is responsible for the diagnosis, treatment, management and overall coordination of services related to patients' oral health needs. |
| Notes: Source: Academy of General Dentistry |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1902941594 | David E Chlysta | Dentist | 6693 N Chestnut Street, Suite 131-a, Ravenna, OH 44266-3922 | 2007-02-21 |
| 1497813935 | John Marshall Brooke | Dentist | 250 S Chestnut St, Ravenna, OH 44266-3031 | 2006-12-05 |
| 1053323311 | Robert Daniel Wicks | Dentist | 4352 Lovers Ln, Ravenna, OH 44266-9132 | 2006-08-13 |
| 1063455129 | Craig R Cameron Dds Plc | Dentist | 12374 Stafford Street, Ravenna, MI 49451-0204 | 2006-06-14 |
| 1689018608 | Sandon Scott Wiedemann | Dentist | 250 S Chestnut St Ste 30, Ravenna, OH 44266-3031 | 2013-04-21 |
| 1801058870 | Michael David Adkins | Dentist | 209 Lawrence St, Ravenna, OH 44266-3214 | 2008-06-30 |
| 1275710840 | Naheed Mohamed | Dentist | 250 S Chestnut St, Suite 30, Ravenna, OH 44266-3031 | 2008-01-25 |
| 1538370473 | James Norman Farris | Dentist | 102 W Seneca St, Ravenna, NE 68869-1363 | 2007-05-24 |
| 1609086024 | Richard Corven Miller | Dentist | 309 E Main St, Ravenna, OH 44266-3107 | 2007-05-23 |
| 1396861944 | William R Braden | Dentist | 250 S Chestnut St, Suite #36, Ravenna, OH 44266-3031 | 2007-03-22 |
| Find all providers in RAVENNA | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.