| NPI | 1144396169 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | EVAN DAVID TETELMAN Vice President Treasurer Dentist 440-461-8200 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: OH 16334) |
| Additional Taxonomies | 122300000X Dentist (Licence: OH 12987) |
| 122300000X Dentist (Licence: OH 14141) | |
| 122300000X Dentist (Licence: OH 20794) | |
| Enumeration Date | 2006-11-28 |
| Last Update Date | 2010-12-27 |