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General NPI Number Information
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NPI Number | 1750782298
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Entity Type | Organization
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Legal Business Name | CENTER FOR ADVANCED PERIODONTAL & IMPLANT CARE, INC.
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Dates
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Enumeration Date | 09/15/2014
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Last Update Date | 09/15/2014
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Provider Practice Location Address
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Address Line | 4410 EXECUTIVE CIR NW
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City | CANTON
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State | OH
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Zip | 44718-2983
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Country | US
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Telephone | 330-494-7004
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Fax | 330-494-7071
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Provider Business Mailing Address
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Address Line | 4410 EXECUTIVE CIR NW
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City | CANTON
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State | OH
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Zip | 44718-2983
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Country | US
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Telephone | 330-494-7004
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Fax | 330-494-7071
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Authorized Official
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Title or Position | CEO
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Name | DR. CONSTANTIN FARAH
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Credential | DDS, MSD
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Telephone | 330-494-7004
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 1223P0300X
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Taxonomy Name | Periodontics
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License Number |
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License Number State |
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