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General NPI Number Information
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NPI Number | 1144396169
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Entity Type | Organization
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Legal Business Name | STREEM RESNICK TETELMAN & YOUNG DDS INC
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Dates
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Enumeration Date | 11/28/2006
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Last Update Date | 12/27/2010
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Provider Practice Location Address
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Address Line | 29001 CEDAR ROAD STE 660
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City | LYNDHURST
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State | OH
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Zip | 44124
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Country | US
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Telephone | 440-461-8200
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Fax | 440-461-8343
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Provider Business Mailing Address
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Address Line | 29001 CEDAR ROAD SUITE 660
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City | LYNDHURST
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State | OH
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Zip | 44124
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Country | US
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Telephone | 440-461-8200
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Fax | 440-461-8343
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Authorized Official
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Title or Position | VICE PRESIDENT TREASURER DENTIST
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Name | DR. EVAN DAVID TETELMAN
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Credential | DDS
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Telephone | 440-461-8200
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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 | 12987
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 14141
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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 | 20794
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License Number State | OH
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Taxonomy #4
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 16334
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License Number State | OH
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