Healthcare Provider Details

I. General information

NPI: 1407347958
Provider Name (Legal Business Name): ERIC YOSKOVICH DDS, MS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/21/2018
Last Update Date: 03/15/2022
Certification Date: 03/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3523 COMMERCIAL DR
FAIRLAWN OH
44333-5107
US

IV. Provider business mailing address

2550 DETROIT AVE APT 458
CLEVELAND OH
44113-2776
US

V. Phone/Fax

Practice location:
  • Phone: 330-668-9977
  • Fax:
Mailing address:
  • Phone: 586-822-7975
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberRES.003950
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number30.026030
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: