MEDICARE: DR. MARY ELEANOR ENDRES D.M.D.

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	1223G0001X	General Practice Dentistry	30022218	OH

General Provider Information

NPI Number	:	1063437325
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARY ELEANOR ENDRES D.M.D.

Provider Business Mailing Address
First Line	:	727 WOODFIELD DR
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45231-2639
Country	:	US
Telephone Number	:	704-277-4756
Fax Number	:

Provider Business Practice Location Address
First Line	:	9215 CINCINNATI COLUMBUS RD
Second Line	:
City	:	WEST CHESTER
State	:	OH
Zip	:	45069-4178
Country	:	US
Telephone Number	:	513-777-5513
Fax Number	:

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

Provider Enumeration Date	:	07/13/2006
Last Update Date	:	07/08/2007

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