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General NPI Number Information
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NPI Number | 1508499567
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Entity Type | Organization
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Legal Business Name | WESTLAKE ENDODONTICS LLC
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Dates
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Enumeration Date | 02/18/2020
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Last Update Date | 02/18/2020
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Provider Practice Location Address
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Address Line | 30400 DETROIT RD STE 209
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City | WESTLAKE
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State | OH
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Zip | 44145-1855
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Country | US
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Telephone | 412-407-2723
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Fax |
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Provider Business Mailing Address
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Address Line | 1918 GEORGETOWN DR
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City | SEWICKLEY
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State | PA
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Zip | 15143-6504
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Country | US
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Telephone | 412-390-8510
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Fax |
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Authorized Official
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Title or Position | ENDODONTIST
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Name | DR. ANAS FATAYER
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Credential | DMD
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Telephone | 412-390-8541
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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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