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General NPI Number Information
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NPI Number | 1164615134
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Entity Type | Organization
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Legal Business Name | UNIVERSITY ORAL AND FACIAL SURGICAL CARE, LLC
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Dates
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Enumeration Date | 08/23/2007
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Last Update Date | 08/23/2007
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Provider Practice Location Address
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Address Line | 2123 ABINGTON RD. 53A
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City | CLEVELAND
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State | OH
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Zip | 44106
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Country | US
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Telephone | 216-368-2538
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Fax |
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Provider Business Mailing Address
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Address Line | 2123 ABINGTON RD.
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City | CLEVELAND
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State | OH
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Zip | 44106
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Country | US
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Telephone | 216-368-2538
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. DALE BAUR
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Credential | DDS
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Telephone | 216-368-2538
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 30017004
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License Number State | OH
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