MEDICARE: SCOTT DAVID PELOK 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	30020109	OH

General Provider Information

NPI Number	:	1477600039
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SCOTT DAVID PELOK DDS

Provider Business Mailing Address
First Line	:	9601 CHESTER AVE STE 345C
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44106-1666
Country	:	US
Telephone Number	:	216-368-2486
Fax Number	:

Provider Business Practice Location Address
First Line	:	9601 CHESTER AVE STE 345C
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44106-1666
Country	:	US
Telephone Number	:	216-368-2486
Fax Number	:

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

Provider Enumeration Date	:	01/05/2007
Last Update Date	:	11/30/2022

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Directions to “ SCOTT DAVID PELOK DDS” Practice Location

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