Provider Demographics
NPI:1891951729
Name:CLEVELAND DENTAL CLINIC
Entity Type:Organization
Organization Name:CLEVELAND DENTAL CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:SALAH
Authorized Official - Middle Name:F
Authorized Official - Last Name:ABOUMONZER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:662-843-6356
Mailing Address - Street 1:4233 HIGHWAY 8
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:MS
Mailing Address - Zip Code:38732-9517
Mailing Address - Country:US
Mailing Address - Phone:662-843-6356
Mailing Address - Fax:662-545-4188
Practice Address - Street 1:4233 HIGHWAY 8
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:MS
Practice Address - Zip Code:38732-9517
Practice Address - Country:US
Practice Address - Phone:662-843-6356
Practice Address - Fax:662-545-4188
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-30
Last Update Date:2008-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty