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General NPI Number Information
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NPI Number | 1962687616
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Entity Type | Organization
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Legal Business Name | DENTAL PROFESSIONALS CLEVELAND-NOUNEH, INC.
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Dates
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Enumeration Date | 12/31/2007
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Last Update Date | 05/13/2009
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Provider Practice Location Address
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Address Line | 1313 W BOGART RD
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City | SANDUSKY
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State | OH
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Zip | 44870-5704
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Country | US
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Telephone | 419-627-1255
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Fax | 419-627-0422
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Provider Business Mailing Address
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Address Line | 6315 PEARL RD STE 201
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City | PARMA HEIGHTS
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State | OH
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Zip | 44130-3074
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Country | US
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Telephone | 440-345-9068
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Fax | 440-842-4612
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Authorized Official
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Title or Position | CREDENTIALING MANAGER
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Name | DIANE L ULICHNEY
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Credential |
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Telephone | 440-345-9068
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 19758
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License Number State | OH
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