MEDICARE: FERNANDO ASCENCIO DMD

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	1223E0200X	Endodontics	DS-30996-L	PA

General Provider Information

NPI Number	:	1275701344
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	FERNANDO ASCENCIO DMD

Provider Business Mailing Address
First Line	:	4065 WASHINGTON RD
Second Line	:
City	:	CANONSBURG
State	:	PA
Zip	:	15317-2520
Country	:	US
Telephone Number	:	724-749-4842
Fax Number	:	724-749-4843

Provider Business Practice Location Address
First Line	:	4065 WASHINGTON RD
Second Line	:
City	:	CANONSBURG
State	:	PA
Zip	:	15317-2520
Country	:	US
Telephone Number	:	724-749-4842
Fax Number	:	724-749-4843

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

Provider Enumeration Date	:	02/12/2008
Last Update Date	:	11/05/2010

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