MEDICARE: MR. MILAN YAKOVICH 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	17625	OH

General Provider Information

NPI Number	:	1215032693
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MILAN YAKOVICH DDS

Provider Business Mailing Address
First Line	:	5851 PEARL RD STE 100
Second Line	:
City	:	PARMA HEIGHTS
State	:	OH
Zip	:	44130-2112
Country	:	US
Telephone Number	:	440-885-0038
Fax Number	:	440-885-5611

Provider Business Practice Location Address
First Line	:	5851 PEARL RD STE 100
Second Line	:
City	:	PARMA HEIGHTS
State	:	OH
Zip	:	44130-2112
Country	:	US
Telephone Number	:	440-885-0038
Fax Number	:	440-885-5611

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

Provider Enumeration Date	:	09/13/2006
Last Update Date	:	07/08/2007

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