Healthcare Provider Details

I. General information

NPI: 1144076340
Provider Name (Legal Business Name): DR. ESMAIEL TAYARA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/29/2024
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9140 LAKE SHORE BLVD
MENTOR OH
44060-1637
US

IV. Provider business mailing address

9140 LAKE SHORE BLVD STE 260
MENTOR OH
44060-1637
US

V. Phone/Fax

Practice location:
  • Phone: 440-257-3900
  • Fax:
Mailing address:
  • Phone: 440-257-3900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number30.028615
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: