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General NPI Number Information
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NPI Number | 1588788525
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Entity Type | Organization
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Legal Business Name | ROSEWATER DENTAL ASSOCIATES, INC.
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Dates
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Enumeration Date | 03/16/2007
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Last Update Date | 12/31/2018
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Provider Practice Location Address
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Address Line | 2626 LORAIN AVE
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City | CLEVELAND
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State | OH
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Zip | 44113-3415
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Country | US
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Telephone | 216-861-2124
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Fax | 216-861-4025
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Provider Business Mailing Address
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Address Line | 2626 LORAIN AVE
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City | CLEVELAND
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State | OH
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Zip | 44113-3415
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Country | US
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Telephone | 216-861-2124
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Fax | 216-861-4025
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. RICHARD A KORMOS
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Credential | D.D.S.
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Telephone | 216-861-2124
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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 | 30-18772
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License Number State | OH
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