Provider Demographics
NPI:1366467284
Name:NJK PREMIER FAMILY DENTAL, INC.
Entity Type:Organization
Organization Name:NJK PREMIER FAMILY DENTAL, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:NADEEM
Authorized Official - Middle Name:J
Authorized Official - Last Name:KOUSSA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:440-268-0768
Mailing Address - Street 1:13477 PROSPECT RD
Mailing Address - Street 2:SUITE 212
Mailing Address - City:STRONGSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44149-3867
Mailing Address - Country:US
Mailing Address - Phone:440-268-0768
Mailing Address - Fax:440-268-0739
Practice Address - Street 1:13477 PROSPECT RD
Practice Address - Street 2:SUITE 212
Practice Address - City:STRONGSVILLE
Practice Address - State:OH
Practice Address - Zip Code:44149-3867
Practice Address - Country:US
Practice Address - Phone:440-268-0768
Practice Address - Fax:440-268-0739
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty