Provider Demographics
NPI:1609192848
Name:CLEVELAND CENTER FOR FAMILY DENTISTRY INC
Entity Type:Organization
Organization Name:CLEVELAND CENTER FOR FAMILY DENTISTRY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NATALIE
Authorized Official - Middle Name:
Authorized Official - Last Name:FARBER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:216-831-6822
Mailing Address - Street 1:28001 CHAGRIN BLVD STE 203
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44122-4543
Mailing Address - Country:US
Mailing Address - Phone:216-831-6822
Mailing Address - Fax:216-831-0910
Practice Address - Street 1:28001 CHAGRIN BLVD STE 203
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44122-4543
Practice Address - Country:US
Practice Address - Phone:216-831-6822
Practice Address - Fax:216-831-0910
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-13
Last Update Date:2010-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30-020653261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2541600Medicaid
OH6365110001Medicare NSC