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General NPI Number Information
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NPI Number | 1417199233
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Entity Type | Individual
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Provider Name | LEVAN JANGIRASHVILI
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Gender | Male
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Dates
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Enumeration Date | 03/25/2009
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Last Update Date | 12/01/2016
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Provider Practice Location Address
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Address Line | 911 N MAIN ST
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City | NORTH CANTON
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State | OH
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Zip | 44720-1919
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Country | US
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Telephone | 330-498-9900
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Fax |
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Provider Business Mailing Address
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Address Line | 911 N MAIN ST
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City | NORTH CANTON
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State | OH
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Zip | 44720-1919
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Country | US
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Telephone | 330-498-9900
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 2651
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 30.023048
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License Number State | OH
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