MEDICARE: DAVID H. VERZELLA, D.D.S.

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	1223G0001X	General Practice Dentistry	3117700	OH

General Provider Information

NPI Number	:	1902928492
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DAVID H. VERZELLA, D.D.S.

Provider Business Mailing Address
First Line	:	4998 W BROAD ST
Second Line	:	SUITE 201
City	:	COLUMBUS
State	:	OH
Zip	:	43228-1647
Country	:	US
Telephone Number	:	614-878-6417
Fax Number	:	614-878-0881

Provider Business Practice Location Address
First Line	:	4998 W BROAD ST
Second Line	:	SUITE 201
City	:	COLUMBUS
State	:	OH
Zip	:	43228-1647
Country	:	US
Telephone Number	:	614-878-6417
Fax Number	:	614-878-0881

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	MELODIE BERRY
Credential	:
Telephone Number	:	614-878-6417

Provider Enumeration Date	:	04/04/2007
Last Update Date	:	06/18/2008

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