| NPI | 1760723902 |
|---|---|
| Doing Business As | NONE |
| Entity Type | Organization |
| Authorized Contact | LISA LANG Director Dept. Of Comprehensive Ca 216-368-5210 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental (Licence: OH 11229) |
| Additional Taxonomies | 261QS0112X Clinic/Center, Oral and Maxillofacial Surgery (Licence: OH 11229) |
| Enumeration Date | 2013-03-13 |
| Last Update Date | 2013-03-13 |