MEDICARE: DR. DENNIS RONALD SZESZKO M.D.

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	207Q00000X	Family Medicine Physician	G2040	TX
2	2083X0100X	Occupational Medicine Physician	G2040	TX

General Provider Information

NPI Number	:	1770731879
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DENNIS RONALD SZESZKO M.D.

Provider Business Mailing Address
First Line	:	13907 MONTFORT DR
Second Line	:	UNIT #433
City	:	DALLAS
State	:	TX
Zip	:	75240-4320
Country	:	US
Telephone Number	:	972-788-4008
Fax Number	:

Provider Business Practice Location Address
First Line	:	13907 MONTFORT DR.
Second Line	:	UNIT # 433
City	:	DALLAS
State	:	TX
Zip	:	75240-4320
Country	:	US
Telephone Number	:	972-788-4008
Fax Number	:

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

Provider Enumeration Date	:	09/03/2008
Last Update Date	:	09/03/2008

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