Provider Demographics
NPI:1649691106
Name:BUCKEYE FAMILY DENTAL PRESENTED BY DR YAZAN ALMADANI LLC
Entity type:Organization
Organization Name:BUCKEYE FAMILY DENTAL PRESENTED BY DR YAZAN ALMADANI LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:YAZAN
Authorized Official - Middle Name:B
Authorized Official - Last Name:AL-MADANI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:440-454-4878
Mailing Address - Street 1:4163 PEARL RD
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44109-3332
Mailing Address - Country:US
Mailing Address - Phone:216-862-4990
Mailing Address - Fax:216-862-3585
Practice Address - Street 1:4163 PEARL RD
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44109-3332
Practice Address - Country:US
Practice Address - Phone:216-862-4990
Practice Address - Fax:216-862-3585
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-30
Last Update Date:2013-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2853630Medicaid