Provider Demographics
NPI:1053044883
Name:MONTAG AND OCRAINICIUC DDS, LLC
Entity type:Organization
Organization Name:MONTAG AND OCRAINICIUC DDS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DALLAS
Authorized Official - Middle Name:
Authorized Official - Last Name:MONTAG
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:740-238-3456
Mailing Address - Street 1:224 LINCOLN WAY E
Mailing Address - Street 2:
Mailing Address - City:MASSILLON
Mailing Address - State:OH
Mailing Address - Zip Code:44646-8416
Mailing Address - Country:US
Mailing Address - Phone:740-238-3456
Mailing Address - Fax:
Practice Address - Street 1:224 LINCOLN WAY E
Practice Address - Street 2:
Practice Address - City:MASSILLON
Practice Address - State:OH
Practice Address - Zip Code:44646-8416
Practice Address - Country:US
Practice Address - Phone:740-238-3456
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MONTAG AND OCRAINICIUC DDS, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-07-08
Last Update Date:2022-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH1932788825OtherDENTIST