Provider Demographics
NPI:1154529295
Name:MODELO DENTAL CENTER INC.
Entity type:Organization
Organization Name:MODELO DENTAL CENTER INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:SARA
Authorized Official - Middle Name:
Authorized Official - Last Name:NAZCO
Authorized Official - Suffix:
Authorized Official - Credentials:DD S
Authorized Official - Phone:216-687-0062
Mailing Address - Street 1:2012 W 25TH ST STE 720
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44113-4131
Mailing Address - Country:US
Mailing Address - Phone:216-687-0062
Mailing Address - Fax:216-687-9529
Practice Address - Street 1:2012 W 25TH ST STE 720
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44113-4131
Practice Address - Country:US
Practice Address - Phone:216-687-0062
Practice Address - Fax:216-687-9529
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-10
Last Update Date:2007-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty