Provider Demographics
NPI:1669242657
Name:ICARE DENTAL LLC
Entity type:Organization
Organization Name:ICARE DENTAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:RAMI
Authorized Official - Middle Name:
Authorized Official - Last Name:MOUDED
Authorized Official - Suffix:
Authorized Official - Credentials:DDS/MPH
Authorized Official - Phone:440-454-4530
Mailing Address - Street 1:31088 BELLERIVE CT
Mailing Address - Street 2:
Mailing Address - City:WESTLAKE
Mailing Address - State:OH
Mailing Address - Zip Code:44145-1893
Mailing Address - Country:US
Mailing Address - Phone:440-454-4530
Mailing Address - Fax:
Practice Address - Street 1:14865 DETROIT AVE
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:OH
Practice Address - Zip Code:44107-3909
Practice Address - Country:US
Practice Address - Phone:216-772-2310
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-02
Last Update Date:2024-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental