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General NPI Number Information
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NPI Number | 1982118584
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Entity Type | Organization
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Legal Business Name | YAZAN F KARADSHEH DDS LLC
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Dates
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Enumeration Date | 11/20/2017
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Last Update Date | 03/25/2023
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Provider Practice Location Address
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Address Line | 6248 N RIDGE RD
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City | MADISON
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State | OH
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Zip | 44057-2567
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Country | US
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Telephone | 440-428-1011
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Fax |
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Provider Business Mailing Address
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Address Line | 6248 N RIDGE RD
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City | MADISON
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State | OH
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Zip | 44057-2567
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Country | US
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Telephone | 440-428-1011
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Fax |
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Authorized Official
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Title or Position | OWNER/OPERATOR
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Name | YAZAN KARADSHEH
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Credential | DDS
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Telephone | 440-454-5436
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 30.024024
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License Number State | OH
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