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General NPI Number Information
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NPI Number | 1174320154
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Entity Type | Organization
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Legal Business Name | ELITE DENTAL ART GHAZAL DDS LLC
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Dates
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Enumeration Date | 02/27/2025
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Last Update Date | 02/27/2025
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Provider Practice Location Address
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Address Line | 4263 FULTON RD UNIT 21
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City | CLEVELAND
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State | OH
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Zip | 44144-1866
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Country | US
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Telephone | 216-415-5504
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Fax |
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Provider Business Mailing Address
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Address Line | 5716 BROADWAY AVE
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City | CLEVELAND
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State | OH
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Zip | 44127-1715
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Country | US
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Telephone | 216-415-5504
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Fax |
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Authorized Official
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Title or Position | MEMBER
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Name | YAZAN HADDADEEN
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Credential | DDS
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Telephone | 216-415-5504
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State |
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