Provider Demographics
NPI:1912428228
Name:YASSEN, GHAETH H (BDS, MSD, PHD)
Entity Type:Individual
Prefix:
First Name:GHAETH
Middle Name:H
Last Name:YASSEN
Suffix:
Gender:M
Credentials:BDS, MSD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:CWRU SCHOOL OF DENTAL MEDICINE
Mailing Address - Street 2:2124 CORNELL DRIVE
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44106-1168
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2124 CORNELL DRIVE
Practice Address - Street 2:CWRU SCHOOL OF DENTAL MEDICINE,
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44106
Practice Address - Country:US
Practice Address - Phone:216-368-3236
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-28
Last Update Date:2017-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0038071223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics