| NPI | 1245507094 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ROBERT LEE Dentist Owner 216-410-7405 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: TX 25844) |
| Additional Taxonomies | 122300000X Dentist (Licence: TX 25994) |
| 122300000X Dentist (Licence: TX 26066) | |
| 1223P0300X Dentist, Periodontics (Licence: TX 18721) | |
| Enumeration Date | 2011-11-22 |
| Last Update Date | 2011-11-22 |