Healthcare Provider Details

I. General information

NPI: 1689317703
Provider Name (Legal Business Name): DR. SARAH BAKER AL-NAZER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/16/2022
Last Update Date: 12/06/2023
Certification Date: 12/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9601 CHESTER AVE
CLEVELAND OH
44106-1666
US

IV. Provider business mailing address

12303 CEDAR RD APT 439
CLEVELAND HEIGHTS OH
44106-3268
US

V. Phone/Fax

Practice location:
  • Phone: 216-368-3200
  • Fax:
Mailing address:
  • Phone: 440-990-6644
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License NumberRES.004558
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number13392
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: