=====================================================
General NPI Number Information
=====================================================
NPI Number | 1336953595
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DR. KAY'S PERIODONTICS AND IMPLANT DENTISTRY
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/06/2025
-----------------------------------------------------
Last Update Date | 02/06/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 484 S MILLER RD STE 200
-----------------------------------------------------
City | FAIRLAWN
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44333-4176
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 330-867-3320
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 19875 CENTER RIDGE RD APT 454
-----------------------------------------------------
City | ROCKY RIVER
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44116-3656
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 216-534-0808
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/PERIODONTIST
-----------------------------------------------------
Name | DR. KHAWLA ALJOHANI
-----------------------------------------------------
Credential | DDS, MSD
-----------------------------------------------------
Telephone | 216-534-0808
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223P0300X
-----------------------------------------------------
Taxonomy Name | Periodontics
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------