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General NPI Number Information
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NPI Number | 1871497677
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Entity Type | Organization
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Legal Business Name | PERIODONTAL ASSOCIATES, INC.
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Dates
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Enumeration Date | 10/05/2026
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Last Update Date | 10/05/2026
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Provider Practice Location Address
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Address Line | 8140 NORTON PKWY STE 200
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City | MENTOR
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State | OH
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Zip | 44060-6042
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Country | US
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Telephone | 440-534-1144
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Fax |
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Provider Business Mailing Address
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Address Line | 8140 NORTON PKWY STE 200
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City | MENTOR
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State | OH
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Zip | 44060-6042
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Country | US
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Telephone | 440-534-1144
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Fax |
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Authorized Official
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Title or Position | VP, PAYOR RELATIONS
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Name | MICHAELA MUNIZ
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Credential |
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Telephone | 469-324-3242
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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 |
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License Number State | NULL
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