Provider Demographics
NPI:1174752521
Name:PROSTHODONTIC ASSOCIATES OF NORTHERN OHIO
Entity type:Organization
Organization Name:PROSTHODONTIC ASSOCIATES OF NORTHERN OHIO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MOHAMMED
Authorized Official - Middle Name:ALI
Authorized Official - Last Name:KANAWATI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MBA, MS
Authorized Official - Phone:440-777-0000
Mailing Address - Street 1:26777 LORAIN RD
Mailing Address - Street 2:SUITE 614
Mailing Address - City:NORTH OLMSTED
Mailing Address - State:OH
Mailing Address - Zip Code:44070-3200
Mailing Address - Country:US
Mailing Address - Phone:440-777-0000
Mailing Address - Fax:440-734-1433
Practice Address - Street 1:26777 LORAIN RD
Practice Address - Street 2:SUITE 614
Practice Address - City:NORTH OLMSTED
Practice Address - State:OH
Practice Address - Zip Code:44070-3200
Practice Address - Country:US
Practice Address - Phone:440-777-0000
Practice Address - Fax:440-734-1433
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-07
Last Update Date:2009-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH300223741223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0700XDental ProvidersDentistProsthodonticsGroup - Single Specialty