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General NPI Number Information
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NPI Number | 1982751046
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Entity Type | Individual
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Provider Name | RICHARD A KORMOS D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 01/04/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 2012 WEST 25TH STREET ROOM 200
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City | CLEVELAND
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State | OH
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Zip | 44113-4131
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Country | US
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Telephone | 216-861-2124
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Fax | 216-861-4025
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Provider Business Mailing Address
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Address Line | 1071 MAPLE CLIFF DR
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City | LAKEWOOD
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State | OH
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Zip | 44107-1251
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Country | US
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Telephone | 216-226-3976
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 30-18772
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License Number State | OH
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