Healthcare Provider Details

I. General information

NPI: 1306824370
Provider Name (Legal Business Name): BINU ABEY EAPEN DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/09/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

435 GRISWOLD RD
ELYRIA OH
44035-2304
US

IV. Provider business mailing address

435 GRISWOLD RD
ELYRIA OH
44035-2304
US

V. Phone/Fax

Practice location:
  • Phone: 440-324-2310
  • Fax: 440-324-9454
Mailing address:
  • Phone: 440-324-2310
  • Fax: 440-324-9454

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number21587
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: