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General NPI Number Information
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NPI Number | 1013266907
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Entity Type | Organization
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Legal Business Name | ANGEL DENTAL CARE
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Dates
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Enumeration Date | 09/06/2012
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Last Update Date | 09/06/2012
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Provider Practice Location Address
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Address Line | 9701 VISTA WAY
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City | GARFIELD HEIGHTS
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State | OH
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Zip | 44125
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Country | US
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Telephone | 216-662-9900
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Fax | 216-662-7099
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Provider Business Mailing Address
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Address Line | 9701 VISTA WAY
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City | GARFIELD HEIGHTS
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State | OH
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Zip | 44125
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Country | US
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Telephone | 216-662-9900
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Fax | 216-662-7099
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Authorized Official
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Title or Position | MEMBER OF LLC
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Name | SAAD ABUZAKYAH
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Credential |
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Telephone | 216-825-5952
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 30.022649
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 30.023152
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License Number State | OH
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Taxonomy #3
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 30.023074
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License Number State | OH
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