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12409 Lorain Avenue Cleveland OH 44111-3515 | |
| (216) 252-6622 | |
| (216) 252-4462 |
| Full Name | |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 12409 Lorain Avenue, Cleveland, Ohio |
| Authorized Official Name and Position | John A Hudec (PRESIDENT) |
| Authorized Official Contact | 2163988900 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
12409 Lorain Avenue Cleveland OH 44111-3515 Ph: (216) 252-6622 | 12409 Lorain Avenue Cleveland OH 44111-3515 Ph: (216) 252-6622 |
| NPI Number | 1891727558 |
|---|---|
| Provider Enumeration Date | 07/06/2006 |
| Last Update Date | 10/11/2007 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1891727558 | NPI | - | NPPES |
| 0476551 | Medicaid | OH |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | (* (Not Available)) | Primary |
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