Provider Demographics
NPI:1982118584
Name:YAZAN F KARADSHEH DDS LLC
Entity Type:Organization
Organization Name:YAZAN F KARADSHEH DDS LLC
Other - Org Name:MADISON DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/OPERATOR
Authorized Official - Prefix:
Authorized Official - First Name:YAZAN
Authorized Official - Middle Name:
Authorized Official - Last Name:KARADSHEH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:440-454-5436
Mailing Address - Street 1:6248 N RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:OH
Mailing Address - Zip Code:44057-2567
Mailing Address - Country:US
Mailing Address - Phone:440-428-1011
Mailing Address - Fax:
Practice Address - Street 1:6248 N RIDGE RD
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:OH
Practice Address - Zip Code:44057-2567
Practice Address - Country:US
Practice Address - Phone:440-428-1011
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-20
Last Update Date:2023-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30.0240241223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH30.024024OtherDENTAL LICENSE