Provider Demographics
NPI:1417199233
Name:JANGIRASHVILI, LEVAN
Entity Type:Individual
Prefix:
First Name:LEVAN
Middle Name:
Last Name:JANGIRASHVILI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:911 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:NORTH CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44720-1919
Mailing Address - Country:US
Mailing Address - Phone:330-498-9900
Mailing Address - Fax:
Practice Address - Street 1:911 N MAIN ST
Practice Address - Street 2:
Practice Address - City:NORTH CANTON
Practice Address - State:OH
Practice Address - Zip Code:44720-1919
Practice Address - Country:US
Practice Address - Phone:330-498-9900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-03-25
Last Update Date:2016-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH26511223G0001X
OH30.0230481223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice