Healthcare Provider Details

I. General information

NPI: 1710066592
Provider Name (Legal Business Name): STUART KLASSMAN DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/03/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3636 MAYFIELD RD AMERICAN DENTAL CENTERS
CLEVELAND HTS OH
44118
US

IV. Provider business mailing address

6140 PARKLAND BLVD #100 AMERICAN DENTAL CENTERS
MAYFIELD HTS OH
44124
US

V. Phone/Fax

Practice location:
  • Phone: 216-291-2600
  • Fax: 216-291-2602
Mailing address:
  • Phone: 440-446-1555
  • Fax: 440-446-1990

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number30013901
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: