Provider Demographics
NPI:1871806562
Name:DENTAL EXPRESS KIDS NILES MICHAEL R. GRIESMER DDS LLC
Entity type:Organization
Organization Name:DENTAL EXPRESS KIDS NILES MICHAEL R. GRIESMER DDS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE ADMIN
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:R
Authorized Official - Last Name:MAUERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-533-3400
Mailing Address - Street 1:6285 YOUNGSTOWN WARREN RD
Mailing Address - Street 2:
Mailing Address - City:NILES
Mailing Address - State:OH
Mailing Address - Zip Code:44446-4656
Mailing Address - Country:US
Mailing Address - Phone:330-505-9224
Mailing Address - Fax:
Practice Address - Street 1:6285 YOUNGSTOWN WARREN RD
Practice Address - Street 2:
Practice Address - City:NILES
Practice Address - State:OH
Practice Address - Zip Code:44446-4656
Practice Address - Country:US
Practice Address - Phone:330-505-9224
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-22
Last Update Date:2010-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30017887122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty