MEDICARE: BUCKEYE FAMILY DENTAL PRESENTED BY DR YAZAN ALMADANI 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		OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1649691106
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BUCKEYE FAMILY DENTAL PRESENTED BY DR YAZAN ALMADANI LLC

Provider Business Mailing Address
First Line	:	4163 PEARL RD
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44109-3332
Country	:	US
Telephone Number	:	216-862-4990
Fax Number	:	216-862-3585

Provider Business Practice Location Address
First Line	:	4163 PEARL RD
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44109-3332
Country	:	US
Telephone Number	:	216-862-4990
Fax Number	:	216-862-3585

Authorized Official
Title or Position	:	GENERAL DENTIST
Name	:	DR. YAZAN B AL-MADANI
Credential	:	DDS
Telephone Number	:	440-454-4878

Provider Enumeration Date	:	12/30/2013
Last Update Date	:	12/30/2013

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