Healthcare Provider Details

I. General information

NPI: 1760723902
Provider Name (Legal Business Name): CASE SCHOOL OF DENTAL MEDICINE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/13/2013
Last Update Date: 03/13/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2124 CORNELL RD
CLEVELAND OH
44106-3804
US

IV. Provider business mailing address

2124 CORNELL RD
CLEVELAND OH
44106-3804
US

V. Phone/Fax

Practice location:
  • Phone: 216-368-5210
  • Fax: 216-368-6771
Mailing address:
  • Phone: 216-368-5210
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number11229
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code261QS0112X
TaxonomyOral and Maxillofacial Surgery Clinic/Center
License Number11229
License Number StateOH

VIII. Authorized Official

Name: DR. LISA LANG
Title or Position: DIRECTOR- DEPT. OF COMPREHENSIVE CA
Credential: D.D.S., M.S.D. M.B.A
Phone: 216-368-5210