MEDICARE: DR. DANY JOSE DMD

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	30024060	OH

General Provider Information

NPI Number	:	1639502784
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DANY JOSE DMD

Provider Business Mailing Address
First Line	:	115 VILLAGE GATE BLVD
Second Line	:
City	:	DELAWARE
State	:	OH
Zip	:	43015-8935
Country	:	US
Telephone Number	:	617-435-0345
Fax Number	:

Provider Business Practice Location Address
First Line	:	1100 SUNBURY RD
Second Line	:
City	:	DELAWARE
State	:	OH
Zip	:	43015-6040
Country	:	US
Telephone Number	:	710-513-3235
Fax Number	:

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

Provider Enumeration Date	:	08/13/2013
Last Update Date	:	08/13/2013

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