=====================================================
General NPI Number Information
=====================================================
NPI Number | 1912302357
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BINU EAPEN DDS INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/28/2014
-----------------------------------------------------
Last Update Date | 10/28/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 20886 DRAKE RD
-----------------------------------------------------
City | STRONGSVILLE
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44149-5850
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 440-572-5055
-----------------------------------------------------
Fax | 440-572-6020
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 20886 DRAKE RD
-----------------------------------------------------
City | STRONGSVILLE
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44149-5850
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 440-572-5055
-----------------------------------------------------
Fax | 440-572-6020
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. BINU EAPEN
-----------------------------------------------------
Credential | DDS
-----------------------------------------------------
Telephone | 440-572-5055
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number | 21587
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------