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NPI Code Detail

MEDICARE: AYAH KOLEILAT DDS

MEDICARE: AYAH KOLEILAT DDS
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1122300000XDentist2901023224MI
21223P0221XPediatric Dentistry30.026862OH

General Provider Information

NPI Number : 1063070233
Entity Type Code : Individual
Provider Name (Legal Business Name) : AYAH KOLEILAT DDS
Provider Business Mailing Address
First Line : 3695 WYNDHAM RIDGE DR APT 208
Second Line :
City : STOW
State : OH
Zip : 44224-6147
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 3523 COMMERCIAL DR
Second Line :
City : FAIRLAWN
State : OH
Zip : 44333-5107
Country : US
Telephone Number : 330-668-9977
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/03/2019
Last Update Date : 07/25/2022

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