Provider Demographics
NPI:1760735708
Name:DENTISTREE, INC.
Entity Type:Organization
Organization Name:DENTISTREE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:L
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MPH
Authorized Official - Phone:216-404-2510
Mailing Address - Street 1:26110 EMERY RD STE 300
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44128-5788
Mailing Address - Country:US
Mailing Address - Phone:216-404-2510
Mailing Address - Fax:
Practice Address - Street 1:26110 EMERY RD
Practice Address - Street 2:SUITE 300
Practice Address - City:WARRENSVILLE HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44128-5787
Practice Address - Country:US
Practice Address - Phone:216-404-2510
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-15
Last Update Date:2013-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty