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General NPI Number Information
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NPI Number | 1841372935
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Entity Type | Organization
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Legal Business Name | CRANIOFACIAL IMAGING CENTER
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Dates
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Enumeration Date | 10/19/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 10900 EUCLID AVE CASE SCHOOL OF DENTAL MEDICINE - 3RD FLOOR
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City | CLEVELAND
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State | OH
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Zip | 44106-1712
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Country | US
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Telephone | 216-368-2674
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Fax | 216-368-3204
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Provider Business Mailing Address
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Address Line | 10900 EUCLID AVE CASE SCHOOL OF DENTAL MEDICINE - 3RD FLOOR
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City | CLEVELAND
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State | OH
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Zip | 44106-1712
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Country | US
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Telephone | 216-368-2674
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Fax | 216-368-3204
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Authorized Official
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Title or Position | CHAIRMAN
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Name | DR. MARK G HANS
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Credential | DDS, MSD
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Telephone | 216-368-4649
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 16067
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License Number State | OH
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