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1611 S Green Rd Suite 157 Cleveland OH 44121-4128 | |
| (216) 381-6521 | |
| (216) 381-9226 |
| Full Name | |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 1611 S Green Rd, Cleveland, Ohio |
| Authorized Official Name and Position | Laura Jean Kennedy (PRACTICE ADMINISTRATOR) |
| Authorized Official Contact | 2163816521 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
1611 S Green Rd Suite 157 Cleveland OH 44121-4128 Ph: (216) 381-6521 | 1611 S Green Rd Suite 157 Cleveland OH 44121-4128 Ph: (216) 381-6521 |
| NPI Number | 1326019233 |
|---|---|
| Provider Enumeration Date | 01/30/2006 |
| Last Update Date | 07/10/2009 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1326019233 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | 30-01-7418 (Ohio) | Primary |
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