Provider Demographics
NPI:1962687616
Name:DENTAL PROFESSIONALS CLEVELAND-NOUNEH, INC.
Entity Type:Organization
Organization Name:DENTAL PROFESSIONALS CLEVELAND-NOUNEH, INC.
Other - Org Name:BRIGHT NOW DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CREDENTIALING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:L
Authorized Official - Last Name:ULICHNEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:440-345-9068
Mailing Address - Street 1:6315 PEARL RD STE 201
Mailing Address - Street 2:
Mailing Address - City:PARMA HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44130-3074
Mailing Address - Country:US
Mailing Address - Phone:440-345-9068
Mailing Address - Fax:440-842-4612
Practice Address - Street 1:1313 W BOGART RD
Practice Address - Street 2:
Practice Address - City:SANDUSKY
Practice Address - State:OH
Practice Address - Zip Code:44870-5704
Practice Address - Country:US
Practice Address - Phone:419-627-1255
Practice Address - Fax:419-627-0422
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DENTAL PROFESSIONAL CLEVELAND-NOUNEH, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-12-31
Last Update Date:2009-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH19758261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2497454Medicaid