Provider Demographics
NPI:1184896433
Name:DENTAL PROFESSIONALS CLEVELAND-LEE,INC.
Entity type:Organization
Organization Name:DENTAL PROFESSIONALS CLEVELAND-LEE,INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:
Authorized Official - Last Name:ULICHNEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:440-324-2310
Mailing Address - Street 1:435 GRISWOLD RD
Mailing Address - Street 2:
Mailing Address - City:ELYRIA
Mailing Address - State:OH
Mailing Address - Zip Code:44035-2304
Mailing Address - Country:US
Mailing Address - Phone:440-324-2310
Mailing Address - Fax:440-324-9467
Practice Address - Street 1:435 GRISWOLD RD
Practice Address - Street 2:
Practice Address - City:ELYRIA
Practice Address - State:OH
Practice Address - Zip Code:44035-2304
Practice Address - Country:US
Practice Address - Phone:440-324-2310
Practice Address - Fax:440-324-9467
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DENTAL PROFESSIONALS CLEVELAND-LL,INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-03-27
Last Update Date:2008-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty