Provider Demographics
NPI:1023131398
Name:TAJOUR, SEIFEDDINE MOHAMAD (DDS)
Entity type:Individual
Prefix:DR
First Name:SEIFEDDINE
Middle Name:MOHAMAD
Last Name:TAJOUR
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27075 SANCTUARY LN
Mailing Address - Street 2:
Mailing Address - City:OLMSTED FALLS
Mailing Address - State:OH
Mailing Address - Zip Code:44138-3727
Mailing Address - Country:US
Mailing Address - Phone:440-427-9060
Mailing Address - Fax:
Practice Address - Street 1:48 N LINWOOD AVE
Practice Address - Street 2:
Practice Address - City:NORWALK
Practice Address - State:OH
Practice Address - Zip Code:44857-1519
Practice Address - Country:US
Practice Address - Phone:419-668-4117
Practice Address - Fax:419-660-8387
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH20839122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2142381Medicaid