NPIMap

Organization Active NPI

Dental Professionals Cleveland-Nouneh, Inc.

  • Dentist
  • Mentor, OH
National Provider Identifier
1548445570
Registry record updated May 12, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
19758 Issued in OH
Legal business name
DENTAL PROFESSIONALS CLEVELAND-NOUNEH, INC.
Practice address
9161 Mentor Ave
Mentor, OH 44060-6403
Phone
(440) 974-9530
Fax
(440) 974-9536
NPI assigned
Jan 9, 2008
Organization subpart
Yes
Parent organization
DENTAL PROFESSIONALS CLEVELAND-LEE, INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on May 12, 2009

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

Authorized official

Name
Diane L Ulichney
Title
Credentialing Manager
Phone
(440) 345-9068

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193200000X MULTI-SPECIALTY GROUP 122300000X 19758 OH Primary

Addresses

Primary practice location

9161 Mentor Ave
Mentor, OH 44060-6403

Mailing address

6315 Pearl Rd Ste 201
Parma Heights, OH 44130-3074
Phone (440) 345-9068

Other identifiers 1

IdentifierTypeStateIssuer
2618680MedicaidOH

Other names 1

  • brightnow dental Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Dental Professionals Cleveland-Nouneh Inc11 organizations share this tax ID, including this one
Part of
Dental Professionals Cleveland-Nouneh Inc

Other organizations with this tax ID 10

Organizations that report the same tax identification number in the National Provider Directory.

Locations

9161 Mentor Ave
Mentor, OH 44060
Phone (440) 974-9530

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1199836800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1242086400000",
    "number": "1548445570",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6315 PEARL RD STE 201",
            "city": "PARMA HEIGHTS",
            "state": "OH",
            "postal_code": "441303074",
            "telephone_number": "440-345-9068",
            "fax_number": "440-842-4612"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9161 MENTOR AVE",
            "city": "MENTOR",
            "state": "OH",
            "postal_code": "440606403",
            "telephone_number": "440-974-9530",
            "fax_number": "440-974-9536"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DENTAL PROFESSIONALS CLEVELAND-NOUNEH, INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "DENTAL PROFESSIONALS CLEVELAND-LEE, INC.",
        "enumeration_date": "2008-01-09",
        "last_updated": "2009-05-12",
        "status": "A",
        "authorized_official_last_name": "ULICHNEY",
        "authorized_official_first_name": "DIANE",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "CREDENTIALING MANAGER",
        "authorized_official_telephone_number": "440-345-9068"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist",
            "state": "OH",
            "license": "19758",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2618680",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "brightnow dental",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Mentor, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 12, 2009; 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.