Provider Demographics
NPI:1992912869
Name:KANAWATI, MOHAMMED ALI (DDS,MBA,MS)
Entity type:Individual
Prefix:DR
First Name:MOHAMMED
Middle Name:ALI
Last Name:KANAWATI
Suffix:
Gender:M
Credentials:DDS,MBA,MS
Other - Prefix:DR
Other - First Name:M.
Other - Middle Name:ALI
Other - Last Name:KANAWATI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS, MBA, MS
Mailing Address - Street 1:3671 COLUMBIA RD
Mailing Address - Street 2:
Mailing Address - City:NORTH OLMSTED
Mailing Address - State:OH
Mailing Address - Zip Code:44070-2038
Mailing Address - Country:US
Mailing Address - Phone:216-450-5888
Mailing Address - Fax:216-450-5505
Practice Address - Street 1:31099 CHAGRIN BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:PEPPER PIKE
Practice Address - State:OH
Practice Address - Zip Code:44124-5958
Practice Address - Country:US
Practice Address - Phone:216-450-5888
Practice Address - Fax:216-450-5505
Is Sole Proprietor?:No
Enumeration Date:2007-05-17
Last Update Date:2020-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30-022374122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH30-022374OtherOHIO STATE DENTAL LICENSE
OH30-022374OtherOHIO STATE DENTAL LICENSE