NPI 1235109604 · live from the CMS NPI Registry
Dr. Dellagatta & Associates (Southern Park), INC.
Dentist, General Practice in Boardman, OH. National Provider Identifier 1235109604, active.
NPI record
| NPI | 1235109604 Type 2 · organization |
|---|---|
| Status | Active |
| Primary specialty | Dentist, General Practice 1223G0001X |
| Practice location | 930 Boardman-Poland Road, Boardman, OH 44512 |
| Practice phone | 330-629-8884 |
| Mailing address | Po Box 860036, Minneapolis, MN 55486 |
| Enumerated | January 26, 2006 |
| Last updated | September 22, 2022 |
| Authorized official | Lauren Hill, Rcm, Director |
| Other names | Dentalworks |
Taxonomies and licenses
| Taxonomy | Code | License |
|---|---|---|
| Dentist | 122300000X | — |
| Dentist, Endodontics | 1223E0200X | — |
| Dentist, Pediatric Dentistry | 1223P0221X | — |
| Dentist, Periodontics | 1223P0300X | — |
| Dentist, Prosthodontics | 1223P0700X | — |
| Dentist, Orthodontics and Dentofacial Orthopedics | 1223X0400X | — |
| Dentist, General Practice primary | 1223G0001X | — |
Source: CMS NPPES NPI Registry. NPI data is self-reported by providers; license numbers are not verified by CMS.