30th & O
Clinic/Center, Oral and Maxillofacial Surgery in Beachwood, OH. Organization (NPI-2).
NPI number1649026022
StatusActive
Last updated in NPPESMay 1, 2024
Details
- NPI
- 1649026022
- Entity type
- Organization (NPI-2)
- Legal business name
- 30th & O
- Organization subpart
- No
- Enumeration date
- Apr 26, 2024
- Certification date
- May 1, 2024
- Last updated
- May 1, 2024
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 261QS0112X | Clinic/Center, Oral and Maxillofacial Surgery | – | – | Yes |
Practice location
3600 Park East Dr Apt 539Beachwood, OH 44122-4358
Phone 440-213-9459
Mailing address
3600 Park East Dr Apt 539Beachwood, OH 44122-4358
Phone 440-213-9459
Authorized official
Jaclyn Tomsic
President
4402139459
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