Provider Demographics
NPI:1760774343
Name:BEACHCLIFF DENTAL ASSOCIATES OF ROCKY RIVER
Entity Type:Organization
Organization Name:BEACHCLIFF DENTAL ASSOCIATES OF ROCKY RIVER
Other - Org Name:ANASTASIA THEODOROU DDS LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ANASTASIA
Authorized Official - Middle Name:
Authorized Official - Last Name:THEODOROU
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:440-250-8775
Mailing Address - Street 1:19111 DETROIT RD
Mailing Address - Street 2:SUITE 204
Mailing Address - City:ROCKY RIVER
Mailing Address - State:OH
Mailing Address - Zip Code:44116-1786
Mailing Address - Country:US
Mailing Address - Phone:440-356-1000
Mailing Address - Fax:
Practice Address - Street 1:19111 DETROIT RD
Practice Address - Street 2:SUITE 204
Practice Address - City:ROCKY RIVER
Practice Address - State:OH
Practice Address - Zip Code:44116-1786
Practice Address - Country:US
Practice Address - Phone:440-356-1000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-13
Last Update Date:2011-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH300224631223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty