| NPI | 1265414536 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JEROME S KUSTIN Dentist/Owner 216-741-4600 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: OH 12902) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: OH 12902) |
| Enumeration Date | 2005-11-14 |
| Last Update Date | 2010-11-29 |