Provider Demographics
NPI:1760723902
Name:CASE SCHOOL OF DENTAL MEDICINE
Entity Type:Organization
Organization Name:CASE SCHOOL OF DENTAL MEDICINE
Other - Org Name:NONE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR- DEPT. OF COMPREHENSIVE CA
Authorized Official - Prefix:DR
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:LANG
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MSD MBA
Authorized Official - Phone:216-368-5210
Mailing Address - Street 1:2124 CORNELL RD
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44106-3804
Mailing Address - Country:US
Mailing Address - Phone:216-368-5210
Mailing Address - Fax:
Practice Address - Street 1:2124 CORNELL RD
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44106-3804
Practice Address - Country:US
Practice Address - Phone:216-368-5210
Practice Address - Fax:216-368-6771
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CASE/WESTERN RESERVE UNIVERSITY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-03-13
Last Update Date:2013-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH11229261QD0000X, 261QS0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
No261QS0112XAmbulatory Health Care FacilitiesClinic/CenterOral and Maxillofacial Surgery