Provider Demographics
NPI:1013266907
Name:ANGEL DENTAL CARE
Entity Type:Organization
Organization Name:ANGEL DENTAL CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER OF LLC
Authorized Official - Prefix:
Authorized Official - First Name:SAAD
Authorized Official - Middle Name:
Authorized Official - Last Name:ABUZAKYAH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:216-825-5952
Mailing Address - Street 1:9701 VISTA WAY
Mailing Address - Street 2:
Mailing Address - City:GARFIELD HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44125
Mailing Address - Country:US
Mailing Address - Phone:216-662-9900
Mailing Address - Fax:216-662-7099
Practice Address - Street 1:9701 VISTA WAY
Practice Address - Street 2:
Practice Address - City:GARFIELD HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44125
Practice Address - Country:US
Practice Address - Phone:216-662-9900
Practice Address - Fax:216-662-7099
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-06
Last Update Date:2012-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30.023074122300000X
OH30.022649122300000X
OH30.0231521223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty
No1223P0221XDental ProvidersDentistPediatric DentistryGroup - Multi-Specialty