Healthcare Provider Details

I. General information

NPI: 1205275153
Provider Name (Legal Business Name): IVAN STOJANOV DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/24/2013
Last Update Date: 09/21/2022
Certification Date: 09/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9500 EUCLID AVE
CLEVELAND OH
44195-3804
US

IV. Provider business mailing address

4849 BRAINARD RD
CHAGRIN FALLS OH
44022-1509
US

V. Phone/Fax

Practice location:
  • Phone: 216-440-2200
  • Fax: 216-368-3627
Mailing address:
  • Phone: 706-294-5456
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ZP0101X
TaxonomyAnatomic Pathology Physician
License Number30.024886
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code1223P0106X
TaxonomyOral and Maxillofacial Pathology Dentistry
License Number30.024886
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: