Provider Demographics
NPI:1760246060
Name:SAAHAS DENTAL LLC
Entity Type:Organization
Organization Name:SAAHAS DENTAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIR. CREDENTIALING & ENROLLMENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:JACOMINO-BARNES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-270-9497
Mailing Address - Street 1:PO BOX 70887
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44190-0887
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2860 S GREEN BAY RD STE 104
Practice Address - Street 2:
Practice Address - City:MOUNT PLEASANT
Practice Address - State:WI
Practice Address - Zip Code:53406-4962
Practice Address - Country:US
Practice Address - Phone:262-886-9700
Practice Address - Fax:262-554-1629
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-08
Last Update Date:2024-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty