Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0300X | Periodontist | RES.3147 | OH |
NPI | 1093157018 |
---|---|
Provider Name | Dr. Abdelazeem Hazem Desoky |
First Address | Beachwood, OH 44122-8103 |
Second Address | Beachwood, OH 44122-8103 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/07/2013 |
Last Update Date | 18/07/2013 |