Eastlake Oh Dentist LLC
Clinic/Center, Dental in Eastlake, OH. Organization (NPI-2).
NPI number1124942008
StatusActive
Last updated in NPPESAug 5, 2026
Details
- NPI
- 1124942008
- Entity type
- Organization (NPI-2)
- Legal business name
- Eastlake Oh Dentist LLC
- Organization subpart
- No
- Enumeration date
- Aug 5, 2026
- Certification date
- Aug 5, 2026
- Last updated
- Aug 5, 2026
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 261QD0000X | Clinic/Center, Dental | – | – | Yes |
Practice location
34051 Vine StEastlake, OH 44095-5107
Phone 651-444-9644
Mailing address
34051 Vine StEastlake, OH 44095-5107
Authorized official
David Park
President/Ceo
4437590910
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