Provider Demographics
NPI:1942223284
Name:TMJ & HEADACHE CENTER LLC
Entity Type:Organization
Organization Name:TMJ & HEADACHE CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SHOKRI
Authorized Official - Middle Name:A
Authorized Official - Last Name:WAHIB
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:440-892-7773
Mailing Address - Street 1:29099 HEALTH CAMPUS DR
Mailing Address - Street 2:STE 220
Mailing Address - City:WESTLAKE
Mailing Address - State:OH
Mailing Address - Zip Code:44145
Mailing Address - Country:US
Mailing Address - Phone:440-892-7773
Mailing Address - Fax:440-892-7616
Practice Address - Street 1:29099 HEALTH CAMPUS DR
Practice Address - Street 2:STE 220
Practice Address - City:WESTLAKE
Practice Address - State:OH
Practice Address - Zip Code:44145
Practice Address - Country:US
Practice Address - Phone:440-892-7773
Practice Address - Fax:440-892-7616
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH197721223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
U87150Medicare UPIN
4040351Medicare ID - Type Unspecified