Healthcare Provider Details

I. General information

NPI: 1073352829
Provider Name (Legal Business Name): ALADDIN MIFALANI
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/21/2024
Last Update Date: 05/21/2024
Certification Date: 05/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5716 BROADWAY AVE
CLEVELAND OH
44127-1715
US

IV. Provider business mailing address

6001 PEBBLEBROOK LN
NORTH OLMSTED OH
44070-4565
US

V. Phone/Fax

Practice location:
  • Phone: 216-415-5504
  • Fax:
Mailing address:
  • Phone: 440-497-8025
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number30.027552
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: