Healthcare Provider Details

I. General information

NPI: 1396729299
Provider Name (Legal Business Name): IMAD NOUNEH DDS, MS
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 12/04/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

270 SANDUSKY ST
ASHLAND OH
44805-2033
US

IV. Provider business mailing address

3203 ROYAL OAK CT
WESTLAKE OH
44145-3770
US

V. Phone/Fax

Practice location:
  • Phone: 419-281-4563
  • Fax:
Mailing address:
  • Phone: 440-899-9981
  • Fax: 440-899-9981

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number20396
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: