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General NPI Number Information
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NPI Number | 1003387531
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Entity Type | Organization
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Legal Business Name | DENTAL PROFESSIONALS CLEVELAND - NOUNEH, INC.
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Dates
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Enumeration Date | 12/10/2018
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Last Update Date | 12/10/2018
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Provider Practice Location Address
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Address Line | 4184 PEARL RD # 103
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City | MEDINA
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State | OH
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Zip | 44256-7648
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Country | US
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Telephone | 330-236-0677
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Fax |
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Provider Business Mailing Address
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Address Line | 100 SPECTRUM CENTER DR STE 100
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City | IRVINE
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State | CA
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Zip | 92618-4963
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Country | US
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Telephone | 714-578-6591
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Fax |
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Authorized Official
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Title or Position | SUPERVISOR
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Name | BEATRIZ HERNANDEZ
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Credential |
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Telephone | 714-578-6591
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State |
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