Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223X0400X | Orthodontists | 17723 | OH |
NPI | 1033110010 |
---|---|
Provider Name | Dr. Shabbir T Adenwalla |
First Address | Cleveland, OH 44130-8361 |
Second Address | Cleveland, OH 44130-8361 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/08/2005 |
Last Update Date | 08/07/2007 |