Provider Demographics
NPI:1245519214
Name:YACOUB, FIRAS GHATTAS (DDS)
Entity type:Individual
Prefix:DR
First Name:FIRAS
Middle Name:GHATTAS
Last Name:YACOUB
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 1:9519 STATE ROUTE 14
Mailing Address - Street 2:
Mailing Address - City:STREETSBORO
Mailing Address - State:OH
Mailing Address - Zip Code:44241-5227
Mailing Address - Country:US
Mailing Address - Phone:216-778-4737
Mailing Address - Fax:216-778-8046
Practice Address - Street 1:9519 STATE ROUTE 14
Practice Address - Street 2:
Practice Address - City:STREETSBORO
Practice Address - State:OH
Practice Address - Zip Code:44241-5227
Practice Address - Country:US
Practice Address - Phone:330-423-6779
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-09
Last Update Date:2021-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30-0240261223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH142703Medicaid
OH142703Medicare PIN