Healthcare Provider Details

I. General information

NPI: 1437180247
Provider Name (Legal Business Name): SOUTHWEST ENDODONTICS & PERIODONTICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/06/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 W WALLINGS RD SUITE B SOUTHWEST ENDO & PERIO INC
BROADVIEW HEIGHTS OH
44147
US

IV. Provider business mailing address

1000 W WALLINGS RD SUITE B SOUTHWEST ENDO & PERIO INC
BROADVIEW HEIGHTS OH
44147
US

V. Phone/Fax

Practice location:
  • Phone: 440-546-1116
  • Fax:
Mailing address:
  • Phone: 440-546-1116
  • Fax: 440-546-0111

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number
License Number State

VIII. Authorized Official

Name: DR. JOONG H HAHN
Title or Position: OWNER
Credential: DDS MSD
Phone: 440-546-1116