MEDICARE: ABOVE AND BEYOND DENTAL , LLC

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	1223G0001X	General Practice Dentistry

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	30.026274	OTHER	OH	OHIO STATE DENTAL BOARD
2	30.024024	OTHER	OH	OHIO STATE DENTAL BOARD

General Provider Information

NPI Number	:	1629771860
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ABOVE AND BEYOND DENTAL , LLC

Provider Business Mailing Address
First Line	:	14401 SNOW RD STE 103
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44142-2583
Country	:	US
Telephone Number	:	440-454-5436
Fax Number	:

Provider Business Practice Location Address
First Line	:	14401 SNOW RD STE 103
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44142-2583
Country	:	US
Telephone Number	:	216-676-4050
Fax Number	:

Authorized Official
Title or Position	:	PARTNER
Name	:	DR. YAZAN F KARADSHEH
Credential	:
Telephone Number	:	440-454-5436

Provider Enumeration Date	:	03/27/2023
Last Update Date	:	03/27/2023

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Directions to “ABOVE AND BEYOND DENTAL , LLC ” Practice Location

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