Provider Demographics
NPI:1033418520
Name:DENTAL PROFESSIONALS CLEVELAND-NOUNEH, INC.
Entity Type:Organization
Organization Name:DENTAL PROFESSIONALS CLEVELAND-NOUNEH, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:ULICHNEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:440-345-9068
Mailing Address - Street 1:6315 PEARL RD
Mailing Address - Street 2:
Mailing Address - City:PARMA HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44130-3082
Mailing Address - Country:US
Mailing Address - Phone:440-345-9068
Mailing Address - Fax:440-842-4612
Practice Address - Street 1:446 HOWE AVE
Practice Address - Street 2:
Practice Address - City:CUYAHOGA FALLS
Practice Address - State:OH
Practice Address - Zip Code:44221-4957
Practice Address - Country:US
Practice Address - Phone:330-734-6179
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-23
Last Update Date:2011-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH203961223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty