Premier Family Dental - Westlake, Koussa, DDS Inc

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

Legal business name

PREMIER FAMILY DENTAL - WESTLAKE, KOUSSA, DDS INC

Practice address

24803 Detroit Rd
Suite a
Westlake, OH 44145-2553

Phone

(440) 835-5388

Fax

(440) 835-2101

NPI assigned

Jul 13, 2006

Last updated

Aug 22, 2020By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Nadeem Koussa, DDS

Title

President

Phone

(440) 835-5388

Specialties & licenses 1

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1152748800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1023033958",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "24803 DETROIT RD",
            "address_2": "SUITE A",
            "city": "WESTLAKE",
            "state": "OH",
            "postal_code": "441452553",
            "telephone_number": "440-835-5388",
            "fax_number": "440-835-2101"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "24803 DETROIT RD",
            "address_2": "SUITE A",
            "city": "WESTLAKE",
            "state": "OH",
            "postal_code": "441452553",
            "telephone_number": "440-835-5388",
            "fax_number": "440-835-2101"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PREMIER FAMILY DENTAL - WESTLAKE, KOUSSA, DDS INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-13",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "KOUSSA",
        "authorized_official_first_name": "NADEEM",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "440-835-5388",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.