Unknown Individual – Oral and Maxillofacial Pathology Dentistry, NPI 1104821933

Unknown Individual is a healthcare provider. based in Kent, Ohio. specializing in Oral and Maxillofacial Pathology Dentistry. They hold a License No. 12449 (OH). The NPI Number for Unknown Individual is 1104821933

Main info

Organization
Inactive
Name
Unknown Individual
NPI
1104821933
Phone
(330) 678-9942
Address
1930 STATE ROUTE 59
Deactivation Date
23 August 2023
Data current as of
19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience14
Completeness75
Years active:0State licenses:1Digital endpointsOther names

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Provider Addresses for Unknown Individual

  • East Main Street, Kent, Portage County, Ohio, 44242, United States

    STE E

    KENT, OH 442404112

    Phone: (330) 678-9942

    Fax: (330) 678-3365

    Mailing address matches the actual address.

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

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Open Payments (CMS)

No Open Payments data available for this provider.

This can happen when there are no reportable CMS Open Payments records.

Medicare Enrollment & Revalidation

Source: CMS public data · Not endorsed by CMS ·

Educational use only—not medical, billing, or legal advice.

No Medicare enrollment or revalidation data available for this provider in our database.

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Medicare Utilization (FFS)

Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·

Educational use only—not medical, billing, or legal advice.

No Medicare fee-for-service utilization data available for this provider in our database.

Insurance plans in this area (ZIP 44240)

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Reviews

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Frequently asked questions

How do I look up Unknown Individual by NPI?
Use NPI 1104821933 when you need to reference Unknown Individual in forms, claims, or directories.
Why would Unknown Individual's listing show inactive?
Inactive in NPPES means the identifier is not currently active in that dataset.
What does Unknown Individual treat or focus on?
Patients typically see Unknown Individual under the specialty Oral and Maxillofacial Pathology Dentistry. Clinical services aligned with this taxonomy classification.
Does Unknown Individual practice in Ohio?
You will see Kent, Ohio on file for Unknown Individual alongside any extra practice locations.
Is this NPI for an individual or an organization?
This listing corresponds to an Individual Provider.

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