Organization
GREAT LAKES DENTALOF WESTLAKE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
STAFANI SANDOVAL (INSURANCE SPECIALIST)
(440) 356-2089
Entity
Organization
Contact information
Practice address
25101 DETROIT RD, SUITE 445, WESTLAKE, OH 44145-2552
(440) 617-9429
(440) 617-9457
Mailing address
19111 DETROIT RD STE 206, ROCKY RIVER, OH 44116-1740
(440) 617-9429
(440) 356-2090
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
022436
OH
Other
Enumeration date
08/31/2010
Last updated
07/28/2021
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