Healthcare Provider Details

I. General information

NPI: 1689663965
Provider Name (Legal Business Name): JASON MICHAEL STREEM D.D.S., M.S.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/19/2005
Last Update Date: 03/12/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29001 CEDAR RD SUITE 450
LYNDHURST OH
44124-4062
US

IV. Provider business mailing address

29001 CEDAR RD SUITE 450
LYNDHURST OH
44124-4062
US

V. Phone/Fax

Practice location:
  • Phone: 440-461-3400
  • Fax:
Mailing address:
  • Phone: 440-461-3400
  • Fax: 440-461-1722

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number30.022255
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: