Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0300X | Periodontist | 17967 | OH |
NPI | 1134207186 |
---|---|
Provider Name | Dr. Scott D. Sazima |
First Address | Westlake, OH 44145-2478 |
Second Address | Westlake, OH 44145-2478 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/11/2006 |
Last Update Date | 26/02/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
X77717 | (02) | OH |