MEDICARE: DR. FIDA E EZZIE 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	30-02-0754	OH

General Provider Information

NPI Number	:	1548368863
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. FIDA E EZZIE DDS

Provider Business Mailing Address
First Line	:	11925 PEARL RD STE 306
Second Line	:
City	:	STRONGSVILLE
State	:	OH
Zip	:	44136-3343
Country	:	US
Telephone Number	:	440-238-2456
Fax Number	:	440-268-2456

Provider Business Practice Location Address
First Line	:	11925 PEARL RD STE 306
Second Line	:
City	:	STRONGSVILLE
State	:	OH
Zip	:	44136-3343
Country	:	US
Telephone Number	:	440-238-2456
Fax Number	:	440-268-2456

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

Provider Enumeration Date	:	09/20/2006
Last Update Date	:	07/08/2007

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