Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0221X | Pediatric Dentist | 30021622 | OH |
NPI | 1083769806 |
---|---|
Provider Name | Dr. Yasser Mohammad Armanazi |
First Address | Mentor, OH 44060-6398 |
Second Address | Mentor, OH 44060-6398 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/01/2007 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2412991 | (05) | OH |