=====================================================
General NPI Number Information
=====================================================
NPI Number | 1679153183
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | AFFORDABLE DENTURES - MENTOR NATALIE FARBER DDS INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/09/2021
-----------------------------------------------------
Last Update Date | 04/09/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9114 MENTOR AVE
-----------------------------------------------------
City | MENTOR
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44060-6404
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 440-205-0616
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 9114 MENTOR AVE
-----------------------------------------------------
City | MENTOR
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44060-6404
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 440-205-0616
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | NATALIE FARBER
-----------------------------------------------------
Credential | DDS
-----------------------------------------------------
Telephone | 440-205-0616
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------