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General NPI Number Information
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NPI Number | 1316762834
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Entity Type | Organization
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Legal Business Name | CENTER RIDGE DENTAL, LLC
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Dates
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Enumeration Date | 11/19/2024
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Last Update Date | 11/19/2024
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Provider Practice Location Address
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Address Line | 33650 CENTER RIDGE RD
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City | NORTH RIDGEVILLE
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State | OH
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Zip | 44039-2574
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Country | US
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Telephone | 440-327-9006
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Fax |
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Provider Business Mailing Address
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Address Line | 551 OAKMOOR RD
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City | BAY VILLAGE
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State | OH
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Zip | 44140-2526
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Country | US
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Telephone | 216-903-1402
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Fax |
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Authorized Official
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Title or Position | DENTIST
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Name | DR. NATHAN HARRIS
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Credential | DDS
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Telephone | 216-903-1402
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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