Healthcare Provider Details

I. General information

NPI: 1295667566
Provider Name (Legal Business Name): ROLAND MEJARES CARREON DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/01/2026
Last Update Date: 06/01/2026
Certification Date: 06/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22901 MILLCREEK BLVD
BEACHWOOD OH
44122-5728
US

IV. Provider business mailing address

22901 MILLCREEK BLVD
BEACHWOOD OH
44122-5728
US

V. Phone/Fax

Practice location:
  • Phone: 216-377-6050
  • Fax:
Mailing address:
  • Phone: 216-377-6050
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberRES.005111
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: