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NPI Code Detail

MEDICARE: UNIVERSITY SUBURBAN DENTAL GROUP, INC

MEDICARE: UNIVERSITY SUBURBAN DENTAL GROUP, INC
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
11223G0001XGeneral Practice Dentistry30-01-7418OH

General Provider Information

NPI Number : 1326019233
Entity Type Code : Organization
Provider Name (Legal Business Name) : UNIVERSITY SUBURBAN DENTAL GROUP, INC
Provider Business Mailing Address
First Line : 1611 S GREEN RD
Second Line : SUITE 157
City : CLEVELAND
State : OH
Zip : 44121-4128
Country : US
Telephone Number : 216-381-6521
Fax Number : 216-381-9226
Provider Business Practice Location Address
First Line : 1611 S GREEN RD
Second Line : SUITE 157
City : CLEVELAND
State : OH
Zip : 44121-4128
Country : US
Telephone Number : 216-381-6521
Fax Number : 216-381-9226
Authorized Official
Title or Position : PRACTICE ADMINISTRATOR
Name : MS. LAURA JEAN KENNEDY
Credential :
Telephone Number : 216-381-6521
Provider Enumeration Date : 01/30/2006
Last Update Date : 07/10/2009

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Directions to “UNIVERSITY SUBURBAN DENTAL GROUP, INC ” Practice Location

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