Healthcare Provider Details

I. General information

NPI: 1821832080
Provider Name (Legal Business Name): MIGUEL ASCENCIO DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2024
Last Update Date: 07/17/2026
Certification Date: 07/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9601 CHESTER AVE
CLEVELAND OH
44106-1666
US

IV. Provider business mailing address

9601 CHESTER AVE
CLEVELAND OH
44106-1666
US

V. Phone/Fax

Practice location:
  • Phone: 216-368-3236
  • Fax:
Mailing address:
  • Phone: 412-759-9340
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License NumberDS045924
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: