| NPI | 1114441417 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GAIL SANDISH Admin Asst 216-485-5788 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics |
| Additional Taxonomies | 1223E0200X Dentist, Endodontics (Licence: OH 30-025207) |
| 1223E0200X Dentist, Endodontics (Licence: OH 30-025210) | |
| 1223G0001X Dentist, General Practice (Licence: OH 30-015265) | |
| 1223P0300X Dentist, Periodontics (Licence: OH 30-025209) | |
| Enumeration Date | 2017-07-28 |
| Last Update Date | 2021-06-17 |