MEDICARE: DR. ALAN G PSOTA DDS

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	14616	OH

General Provider Information

NPI Number	:	1154344943
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ALAN G PSOTA DDS

Provider Business Mailing Address
First Line	:	7123 PEARL RD
Second Line	:	SUITE 100
City	:	CLEVELAND
State	:	OH
Zip	:	44130-4975
Country	:	US
Telephone Number	:	440-888-6783
Fax Number	:

Provider Business Practice Location Address
First Line	:	7123 PEARL RD
Second Line	:	SUITE 100
City	:	CLEVELAND
State	:	OH
Zip	:	44130-4975
Country	:	US
Telephone Number	:	440-888-6783
Fax Number	:

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

Provider Enumeration Date	:	07/25/2006
Last Update Date	:	07/08/2007

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