MEDICARE: DR. CHARLES ROGER ZODY II 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	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	30-01-9272	OH

General Provider Information

NPI Number	:	1093958597
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHARLES ROGER ZODY II D.D.S.

Provider Business Mailing Address
First Line	:	3300 RIVERSIDE DR
Second Line	:	SUITE 150
City	:	UPPER ARLINGTON
State	:	OH
Zip	:	43221-1738
Country	:	US
Telephone Number	:	614-451-0651
Fax Number	:	614-451-6151

Provider Business Practice Location Address
First Line	:	3300 RIVERSIDE DR
Second Line	:	SUITE 150
City	:	UPPER ARLINGTON
State	:	OH
Zip	:	43221-1738
Country	:	US
Telephone Number	:	614-451-0651
Fax Number	:	614-451-6151

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

Provider Enumeration Date	:	04/13/2009
Last Update Date	:	04/13/2009

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