MEDICARE: DR. ZENON FARIAN

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
1	122300000X	Dentist	18964	OH

General Provider Information

NPI Number	:	1225314594
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DR. ZENON FARIAN

Provider Business Mailing Address
First Line	:	229 E WALLINGS RD STE 100
Second Line	:
City	:	BROADVIEW HEIGHTS
State	:	OH
Zip	:	44147-1207
Country	:	US
Telephone Number	:	440-526-9100
Fax Number	:

Provider Business Practice Location Address
First Line	:	229 E WALLINGS RD STE 100
Second Line	:
City	:	BROADVIEW HEIGHTS
State	:	OH
Zip	:	44147-1207
Country	:	US
Telephone Number	:	440-526-9100
Fax Number	:

Authorized Official
Title or Position	:	DENTIST
Name	:	ZENON FARIAN
Credential	:	DDS
Telephone Number	:	440-526-9100

Provider Enumeration Date	:	10/31/2011
Last Update Date	:	10/31/2011

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