Provider Demographics
NPI:1063282432
Name:CHAGRIN FALLS DENTAL BRESCIANI LLC
Entity type:Organization
Organization Name:CHAGRIN FALLS DENTAL BRESCIANI LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JACOB
Authorized Official - Middle Name:
Authorized Official - Last Name:BRESCIANI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:440-247-8641
Mailing Address - Street 1:45 E WASHINGTON ST STE 301
Mailing Address - Street 2:
Mailing Address - City:CHAGRIN FALLS
Mailing Address - State:OH
Mailing Address - Zip Code:44022-3034
Mailing Address - Country:US
Mailing Address - Phone:440-247-8641
Mailing Address - Fax:440-247-5448
Practice Address - Street 1:45 E WASHINGTON ST STE 301
Practice Address - Street 2:
Practice Address - City:CHAGRIN FALLS
Practice Address - State:OH
Practice Address - Zip Code:44022-3034
Practice Address - Country:US
Practice Address - Phone:440-247-8641
Practice Address - Fax:440-247-5448
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-05
Last Update Date:2024-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental