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General NPI Number Information
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NPI Number | 1538361688
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Entity Type | Individual
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Provider Name | JOSE ISAAC ARAUZ-DUTARI D.M.D.
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Gender | Male
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Dates
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Enumeration Date | 06/01/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 5001 MAYFIELD RD STE 305
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City | LYNDHURST
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State | OH
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Zip | 44124-2610
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Country | US
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Telephone | 216-382-8858
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Fax |
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Provider Business Mailing Address
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Address Line | 7298 MEADOW BROOKE WAY
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City | NORTHFIELD
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State | OH
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Zip | 44067
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Country | US
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Telephone | 216-577-6061
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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 | 1223P0300X
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Taxonomy Name | Periodontics
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License Number | 30022076
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License Number State | OH
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