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General NPI Number Information
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NPI Number | 1285933788
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Entity Type | Organization
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Legal Business Name | DENTAL PROFESSIONALS CLEVELAND-NOUNEH, INC.
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Dates
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Enumeration Date | 03/23/2011
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Last Update Date | 03/23/2011
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Provider Practice Location Address
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Address Line | 25102 BROOKPARK RD
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City | NORTH OLMSTED
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State | OH
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Zip | 44070-6414
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Country | US
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Telephone | 440-471-6133
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Fax |
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Provider Business Mailing Address
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Address Line | 6315 PEARL RD
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City | PARMA HEIGHTS
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State | OH
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Zip | 44130-3042
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Country | US
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Telephone | 440-345-9068
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Fax | 440-842-4612
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Authorized Official
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Title or Position | CREDENTIALING MANAGER
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Name | MRS. DIANE LYNN ULICHNEY
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Credential |
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Telephone | 440-345-9068
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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 | 20396
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License Number State | OH
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