Provider Demographics
NPI:1942891981
Name:HUDEPOHL FAMILY DENTISTRY LLC
Entity type:Organization
Organization Name:HUDEPOHL FAMILY DENTISTRY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:
Authorized Official - Last Name:HUDEPOHL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:216-481-9900
Mailing Address - Street 1:812 E 185TH ST
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44119-2702
Mailing Address - Country:US
Mailing Address - Phone:216-481-9900
Mailing Address - Fax:
Practice Address - Street 1:812 E 185TH ST
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44119-2702
Practice Address - Country:US
Practice Address - Phone:216-481-9900
Practice Address - Fax:216-481-8779
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-02
Last Update Date:2021-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty