Provider Demographics
NPI:1174320154
Name:ELITE DENTAL ART GHAZAL DDS LLC
Entity type:Organization
Organization Name:ELITE DENTAL ART GHAZAL DDS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:YAZAN
Authorized Official - Middle Name:
Authorized Official - Last Name:HADDADEEN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:216-415-5504
Mailing Address - Street 1:5716 BROADWAY AVE
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44127-1715
Mailing Address - Country:US
Mailing Address - Phone:216-415-5504
Mailing Address - Fax:
Practice Address - Street 1:4263 FULTON RD UNIT 21
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44144-1866
Practice Address - Country:US
Practice Address - Phone:216-415-5504
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-02-27
Last Update Date:2025-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty