Provider Demographics
NPI:1356361257
Name:MIDDLEBURG HEIGHTS DENTISTRY
Entity type:Organization
Organization Name:MIDDLEBURG HEIGHTS DENTISTRY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:JAY
Authorized Official - Last Name:KLINEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:440-888-6783
Mailing Address - Street 1:7123 PEARL ROAD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:MIDDLEBURG HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44130
Mailing Address - Country:US
Mailing Address - Phone:440-888-6783
Mailing Address - Fax:440-888-8399
Practice Address - Street 1:7123 PEARL RD
Practice Address - Street 2:SUITE 100
Practice Address - City:MIDDLEBURG HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44130
Practice Address - Country:US
Practice Address - Phone:440-888-6783
Practice Address - Fax:440-888-8399
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:JONATHAN J KLINEMAN DDS INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-07-20
Last Update Date:2015-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH14616122300000X
OH21039122300000X
1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
No122300000XDental ProvidersDentistGroup - Single Specialty