MEDICARE: DR. ANDREW SOMTHALA ONELA 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	5102-015	WI

General Provider Information

NPI Number	:	1376615583
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANDREW SOMTHALA ONELA DDS

Provider Business Mailing Address
First Line	:	2727 W CLEVELAND AVE
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53215-2956
Country	:	US
Telephone Number	:	414-383-5500
Fax Number	:	414-383-5400

Provider Business Practice Location Address
First Line	:	2727 W CLEVELAND AVE
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53215-2956
Country	:	US
Telephone Number	:	414-383-5500
Fax Number	:	414-383-5400

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

Provider Enumeration Date	:	11/14/2006
Last Update Date	:	05/25/2010

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