MEDICARE: DR. CASEY L O'CONOR 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	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	30-18160	OH

General Provider Information

NPI Number	:	1780663385
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CASEY L O'CONOR DDS

Provider Business Mailing Address
First Line	:	35836 CENTER RIDGE RD
Second Line	:
City	:	NORTH RIDGEVILLE
State	:	OH
Zip	:	44039-3071
Country	:	US
Telephone Number	:	440-327-9036
Fax Number	:	440-327-7938

Provider Business Practice Location Address
First Line	:	35836 CENTER RIDGE RD
Second Line	:
City	:	NORTH RIDGEVILLE
State	:	OH
Zip	:	44039-3071
Country	:	US
Telephone Number	:	440-327-9036
Fax Number	:	440-327-7938

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

Provider Enumeration Date	:	01/11/2006
Last Update Date	:	07/08/2007

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