Active NPI
Nabil F Bissada, DDS, MSD
- Periodontics
- South Euclid, OH
National Provider Identifier
1669537460
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Periodontics
- License
- 30.016035
- Practice address
- 1611 S Green Rd
#201
South Euclid, OH 44121-4128 - Phone
- (216) 291-2005
- Fax
- (440) 247-1113
- NPI assigned
- Dec 22, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Periodontics | 1223P0300X | 30.016035 | OH | Primary |
Addresses
Primary practice location
1611 S Green Rd
#201
South Euclid, OH 44121-4128
Mailing address
1611 S Green Rd
#201
South Euclid, OH 44121-4128
Phone (216) 291-2005
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 30.016035 | OH | MD | Periodontist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1166745600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1669537460",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1611 S GREEN RD",
"address_2": "#201",
"city": "SOUTH EUCLID",
"state": "OH",
"postal_code": "441214128",
"telephone_number": "216-291-2005",
"fax_number": "440-247-1113"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1611 S GREEN RD",
"address_2": "#201",
"city": "SOUTH EUCLID",
"state": "OH",
"postal_code": "441214128",
"telephone_number": "216-291-2005",
"fax_number": "440-247-1113"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BISSADA",
"first_name": "NABIL",
"middle_name": "F",
"name_prefix": "Dr.",
"credential": "DDS, MSD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-12-22",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "1223P0300X",
"taxonomy_group": "",
"desc": "Dentist, Periodontics",
"state": "OH",
"license": "30.016035",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in South Euclid, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.