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2124 Cornell Rd Cleveland OH 44106-3804 | |
| (216) 368-5210 | |
| (216) 368-6771 |
| Full Name | |
|---|---|
| Speciality | Clinic/center - Dental |
| Location | 2124 Cornell Rd, Cleveland, Ohio |
| Authorized Official Name and Position | Lisa Lang (DIRECTOR- DEPT. OF COMPREHENSIVE CA) |
| Authorized Official Contact | 2163685210 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
2124 Cornell Rd Cleveland OH 44106-3804 Ph: (216) 368-5210 | 2124 Cornell Rd Cleveland OH 44106-3804 Ph: (216) 368-5210 |
| NPI Number | 1760723902 |
|---|---|
| Provider Enumeration Date | 03/13/2013 |
| Last Update Date | 03/13/2013 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1760723902 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | 11229 (Ohio) | Primary |
| 261QS0112X | Clinic/center - Oral And Maxillofacial Surgery | 11229 (Ohio) | Secondary |
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