MEDICARE: JOHN NABIL NASSIF ESTEMALIK BSC, MSD

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	1223P0300X	Periodontics	30.024590	OH

General Provider Information

NPI Number	:	1760723738
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN NABIL NASSIF ESTEMALIK BSC, MSD

Provider Business Mailing Address
First Line	:	11 S MILL ST STE 200
Second Line	:
City	:	NEW CASTLE
State	:	PA
Zip	:	16101-3680
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	7131 SPRING MDWS W STE C
Second Line	:
City	:	HOLLAND
State	:	OH
Zip	:	43528-7938
Country	:	US
Telephone Number	:	419-865-7433
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/15/2013
Last Update Date	:	10/10/2017

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