MEDICARE: DR. CHELSEY KATHERINE CUETO D.D.S

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	30-023726	OH

General Provider Information

NPI Number	:	1003244005
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHELSEY KATHERINE CUETO D.D.S

Provider Business Mailing Address
First Line	:	8839 SCOTSLANDING CIR NW
Second Line	:
City	:	MASSILLON
State	:	OH
Zip	:	44646-1207
Country	:	US
Telephone Number	:	330-806-8763
Fax Number	:

Provider Business Practice Location Address
First Line	:	6451 FRANK AVE NW
Second Line	:
City	:	NORTH CANTON
State	:	OH
Zip	:	44720-8412
Country	:	US
Telephone Number	:	330-806-8763
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/29/2013
Last Update Date	:	10/29/2013

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