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4163 Pearl Rd 28651 Touchstone Cir Cleveland OH 44109-3332 | |
| (440) 454-4878 | |
| (216) 862-3585 |
| Full Name | |
|---|---|
| Speciality | Dentist |
| Location | 4163 Pearl Rd, Cleveland, Ohio |
| Authorized Official Name and Position | Cathryn Buckner (OFFICE MANAGER) |
| Authorized Official Contact | 2162683060 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
4163 Pearl Rd 28651 Touchstone Cir Cleveland OH 44109-3332 Ph: (440) 454-4878 | 4163 Pearl Rd 28651 Touchstone Cir Cleveland OH 44109-3332 Ph: (440) 454-4878 |
| NPI Number | 1982142113 |
|---|---|
| Provider Enumeration Date | 02/08/2017 |
| Last Update Date | 02/08/2017 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1982142113 | NPI | - | NPPES |
| 0066021 | Medicaid | OH |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | (* (Not Available)) | Primary |
| 1223P0221X | Dentist - Pediatric Dentistry | (* (Not Available)) | Secondary |
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