Provider Demographics
NPI:1144396169
Name:STREEM RESNICK TETELMAN & YOUNG DDS INC
Entity Type:Organization
Organization Name:STREEM RESNICK TETELMAN & YOUNG DDS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT TREASURER DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:EVAN
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:TETELMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:440-461-8200
Mailing Address - Street 1:29001 CEDAR ROAD
Mailing Address - Street 2:SUITE 660
Mailing Address - City:LYNDHURST
Mailing Address - State:OH
Mailing Address - Zip Code:44124
Mailing Address - Country:US
Mailing Address - Phone:440-461-8200
Mailing Address - Fax:440-461-8343
Practice Address - Street 1:29001 CEDAR ROAD
Practice Address - Street 2:STE 660
Practice Address - City:LYNDHURST
Practice Address - State:OH
Practice Address - Zip Code:44124
Practice Address - Country:US
Practice Address - Phone:440-461-8200
Practice Address - Fax:440-461-8343
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-28
Last Update Date:2010-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH16334122300000X
OH12987122300000X
OH14141122300000X
OH20794122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH6411030001Medicare NSC