MEDICARE: DR. MICHELE VUCINICH D.M.D,

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	30-016872	OH

General Provider Information

NPI Number	:	1518061084
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHELE VUCINICH D.M.D,

Provider Business Mailing Address
First Line	:	1240 CRESCENT HEIGHTS RD
Second Line	:
City	:	MARION
State	:	OH
Zip	:	43302-6408
Country	:	US
Telephone Number	:	740-387-5196
Fax Number	:

Provider Business Practice Location Address
First Line	:	1240 CRESCENT HEIGHTS RD
Second Line	:
City	:	MARION
State	:	OH
Zip	:	43302-6408
Country	:	US
Telephone Number	:	740-387-5196
Fax Number	:

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

Provider Enumeration Date	:	09/12/2006
Last Update Date	:	07/08/2007

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