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General NPI Number Information
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NPI Number | 1275302663
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Entity Type | Organization
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Legal Business Name | KONTOVEROS KLOBAS MEDINA LLC
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Dates
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Enumeration Date | 12/27/2023
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Last Update Date | 12/27/2023
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Provider Practice Location Address
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Address Line | 2736 MEDINA RD STE 114
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City | MEDINA
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State | OH
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Zip | 44256-9801
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Country | US
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Telephone | 216-860-1195
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Fax |
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Provider Business Mailing Address
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Address Line | 2736 MEDINA RD STE 114
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City | MEDINA
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State | OH
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Zip | 44256-9801
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | GEORGE KONTOVEROS
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Credential | DMD
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Telephone | 216-860-1195
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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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Taxonomy #2
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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