MEDICARE: DR. MINDY JILL STREEM DMD, MS

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	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	30-022478	OH

General Provider Information

NPI Number	:	1750567673
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MINDY JILL STREEM DMD, MS

Provider Business Mailing Address
First Line	:	34501 AURORA RD STE 305
Second Line	:
City	:	SOLON
State	:	OH
Zip	:	44139-3831
Country	:	US
Telephone Number	:	440-248-4825
Fax Number	:	440-248-5489

Provider Business Practice Location Address
First Line	:	34501 AURORA RD STE 305
Second Line	:
City	:	SOLON
State	:	OH
Zip	:	44139-3831
Country	:	US
Telephone Number	:	440-248-4825
Fax Number	:	440-248-5489

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

Provider Enumeration Date	:	01/10/2008
Last Update Date	:	07/06/2011

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