Healthcare Provider Details

I. General information

NPI: 1568442937
Provider Name (Legal Business Name): JOSEPH ANTHONY JEZ D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7043 REARL RD.
MIDDLEBURG HTS OH
44135
US

IV. Provider business mailing address

24314 BRUCE RD
BAY VILLAGE OH
44140-2938
US

V. Phone/Fax

Practice location:
  • Phone: 440-845-7900
  • Fax:
Mailing address:
  • Phone: 440-808-8613
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number18611
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: