=====================================================
General NPI Number Information
=====================================================
NPI Number | 1083769806
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | YASSER MOHAMMAD ARMANAZI DDS
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/24/2007
-----------------------------------------------------
Last Update Date | 07/09/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9179 MENTOR AVE SIUTE # G
-----------------------------------------------------
City | MENTOR
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44060-6398
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 440-266-5437
-----------------------------------------------------
Fax | 440-974-6630
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 9179 MENTOR AVE SIUTE # G
-----------------------------------------------------
City | MENTOR
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44060-6398
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 440-266-5437
-----------------------------------------------------
Fax | 440-974-6630
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223P0221X
-----------------------------------------------------
Taxonomy Name | Pediatric Dentistry
-----------------------------------------------------
License Number | 30021622
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------