Individual
MERCURIOUS MINA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
9601 CHESTER AVE, CLEVELAND, OH 44106-1666
(216) 368-3200
Mailing address
35 SEVERANCE CIR, CLEVELAND HEIGHTS, OH 44118-1523
(216) 797-0500
Taxonomy
Speciality
Code
Description
License number
State
1223P0300X
Periodontics
Primary
RES.004174
OH
Other
Enumeration date
07/10/2020
Last updated
07/10/2020
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