MEDICARE: DR. BYRON (NONE) ROSSI 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	122300000X	Dentist	18861	OH

General Provider Information

NPI Number	:	1588716310
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BYRON (NONE) ROSSI DDS

Provider Business Mailing Address
First Line	:	2013 DORNOCH DR
Second Line	:
City	:	UNIONTOWN
State	:	OH
Zip	:	44685-8819
Country	:	US
Telephone Number	:	330-806-4457
Fax Number	:	330-868-5003

Provider Business Practice Location Address
First Line	:	549 2ND ST NW
Second Line	:
City	:	CARROLLTON
State	:	OH
Zip	:	44615-1003
Country	:	US
Telephone Number	:	330-627-5005
Fax Number	:	330-627-5003

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

Provider Enumeration Date	:	01/18/2007
Last Update Date	:	11/22/2013

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