MEDICARE: DR. ANDREA LONDONO SHISHEHBOR D.D.S.

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	30.022844	OH

General Provider Information

NPI Number	:	1538327077
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANDREA LONDONO SHISHEHBOR D.D.S.

Provider Business Mailing Address
First Line	:	3758 BAINBRIDGE RD
Second Line	:
City	:	CLEVELAND HTS
State	:	OH
Zip	:	44118-2244
Country	:	US
Telephone Number	:	440-479-2535
Fax Number	:	216-320-9810

Provider Business Practice Location Address
First Line	:	3758 BAINBRIDGE RD
Second Line	:
City	:	CLEVELAND HTS
State	:	OH
Zip	:	44118-2244
Country	:	US
Telephone Number	:	440-479-2535
Fax Number	:	216-320-9810

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

Provider Enumeration Date	:	05/31/2008
Last Update Date	:	07/17/2008

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