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General NPI Number Information
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NPI Number | 1164973533
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Entity Type | Organization
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Legal Business Name | CENTER FOR DENTAL HEALTH
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Dates
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Enumeration Date | 10/20/2016
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Last Update Date | 10/20/2016
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Provider Practice Location Address
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Address Line | 32001 VINE ST
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City | WILLOWICK
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State | OH
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Zip | 44095-3572
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Country | US
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Telephone | 440-944-3000
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Fax |
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Provider Business Mailing Address
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Address Line | 32001 VINE ST
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City | WILLOWICK
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State | OH
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Zip | 44095-3572
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Country | US
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Telephone | 440-944-3000
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Fax |
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Authorized Official
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Title or Position | DENTIST
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Name | MS. ERICA MICHELLE WAZNEY
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Credential | DMD
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Telephone | 216-831-8118
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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 | 30022314
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License Number State | OH
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