Provider Demographics
NPI:1750782298
Name:CENTER FOR ADVANCED PERIODONTAL & IMPLANT CARE, INC.
Entity type:Organization
Organization Name:CENTER FOR ADVANCED PERIODONTAL & IMPLANT CARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:CONSTANTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:FARAH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MSD
Authorized Official - Phone:330-494-7004
Mailing Address - Street 1:4410 EXECUTIVE CIR NW
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44718-2983
Mailing Address - Country:US
Mailing Address - Phone:330-494-7004
Mailing Address - Fax:330-494-7071
Practice Address - Street 1:4410 EXECUTIVE CIR NW
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44718-2983
Practice Address - Country:US
Practice Address - Phone:330-494-7004
Practice Address - Fax:330-494-7071
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-15
Last Update Date:2014-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Multi-Specialty
No122300000XDental ProvidersDentistGroup - Multi-Specialty