MEDICARE: DR. STEPHEN T CAROSELLO 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	1223G0001X	General Practice Dentistry	30-01-4053	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1164425146
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. STEPHEN T CAROSELLO DDS

Provider Business Mailing Address
First Line	:	9500 MENTOR AVE
Second Line	:	STE 280
City	:	MENTOR
State	:	OH
Zip	:	44060-8715
Country	:	US
Telephone Number	:	440-352-2887
Fax Number	:	440-352-7611

Provider Business Practice Location Address
First Line	:	9500 MENTOR AVE
Second Line	:	STE 280
City	:	MENTOR
State	:	OH
Zip	:	44060-8715
Country	:	US
Telephone Number	:	440-352-2887
Fax Number	:	440-352-7611

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

Provider Enumeration Date	:	05/24/2005
Last Update Date	:	07/08/2007

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