Provider Demographics
NPI:1144687880
Name:CHAGRIN HIGHLANDS DENTAL GROUP, DOUGLAS E. DESATNIK, D.D.S., LLC
Entity type:Organization
Organization Name:CHAGRIN HIGHLANDS DENTAL GROUP, DOUGLAS E. DESATNIK, D.D.S., LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:
Authorized Official - Last Name:DESATNIK
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:216-464-9800
Mailing Address - Street 1:22901 MILLCREEK BLVD
Mailing Address - Street 2:SUITE #140
Mailing Address - City:BEACHWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44122-5728
Mailing Address - Country:US
Mailing Address - Phone:216-464-9800
Mailing Address - Fax:216-464-9833
Practice Address - Street 1:22901 MILLCREEK BLVD
Practice Address - Street 2:SUITE #140
Practice Address - City:BEACHWOOD
Practice Address - State:OH
Practice Address - Zip Code:44122-5728
Practice Address - Country:US
Practice Address - Phone:216-464-9800
Practice Address - Fax:216-464-9833
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-26
Last Update Date:2016-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30023233261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental