Provider Demographics
NPI:1053406884
Name:WATERLOO DENTAL ASSOCIATES
Entity type:Organization
Organization Name:WATERLOO DENTAL ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:
Authorized Official - Last Name:DROBA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:330-773-0331
Mailing Address - Street 1:475 E WATERLOO RD
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44319-1240
Mailing Address - Country:US
Mailing Address - Phone:330-773-0331
Mailing Address - Fax:330-773-4206
Practice Address - Street 1:475 E WATERLOO RD
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44319-1240
Practice Address - Country:US
Practice Address - Phone:330-773-0331
Practice Address - Fax:330-773-4206
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-04
Last Update Date:2008-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30.0176471223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty