Healthcare Provider Details

I. General information

NPI: 1568676906
Provider Name (Legal Business Name): MICHAEL LEW OKUN D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/09/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

34840 CHARDON RD
WILLOUGHBY OH
44094-9103
US

IV. Provider business mailing address

34840 CHARDON RD
WILLOUGHBY OH
44094-9103
US

V. Phone/Fax

Practice location:
  • Phone: 440-516-0605
  • Fax:
Mailing address:
  • Phone: 440-516-0605
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number17137
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: