Provider Demographics
NPI:1841372935
Name:CRANIOFACIAL IMAGING CENTER
Entity type:Organization
Organization Name:CRANIOFACIAL IMAGING CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHAIRMAN
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:G
Authorized Official - Last Name:HANS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MSD
Authorized Official - Phone:216-368-4649
Mailing Address - Street 1:10900 EUCLID AVE
Mailing Address - Street 2:CASE SCHOOL OF DENTAL MEDICINE - 3RD FLOOR
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44106-1712
Mailing Address - Country:US
Mailing Address - Phone:216-368-2674
Mailing Address - Fax:216-368-3204
Practice Address - Street 1:10900 EUCLID AVE
Practice Address - Street 2:CASE SCHOOL OF DENTAL MEDICINE - 3RD FLOOR
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44106-1712
Practice Address - Country:US
Practice Address - Phone:216-368-2674
Practice Address - Fax:216-368-3204
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH160671223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty