MEDICARE: RICHMOND HEIGHTS DENTAL ARTS LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry

General Provider Information

NPI Number	:	1063057487
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RICHMOND HEIGHTS DENTAL ARTS LLC

Provider Business Mailing Address
First Line	:	27127 CHARDON RD
Second Line	:
City	:	RICHMOND HEIGHTS
State	:	OH
Zip	:	44143-1115
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	27127 CHARDON RD
Second Line	:
City	:	RICHMOND HEIGHTS
State	:	OH
Zip	:	44143-1115
Country	:	US
Telephone Number	:	440-943-1117
Fax Number	:

Authorized Official
Title or Position	:	CHIEF OPERATING OFFICER
Name	:	MR. VIMAL BHATNAGAR
Credential	:
Telephone Number	:	216-849-4002

Provider Enumeration Date	:	11/08/2019
Last Update Date	:	11/08/2019

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