MEDICARE: DR WEI TATAKIS & ASSOCIATES, INC

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		OH

General Provider Information

NPI Number	:	1942474325
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DR WEI TATAKIS & ASSOCIATES, INC

Provider Business Mailing Address
First Line	:	2140 NOBLE RD
Second Line	:
City	:	EAST CLEVELAND
State	:	OH
Zip	:	44112-1736
Country	:	US
Telephone Number	:	216-268-3060
Fax Number	:

Provider Business Practice Location Address
First Line	:	2140 NOBLE RD
Second Line	:
City	:	EAST CLEVELAND
State	:	OH
Zip	:	44112
Country	:	US
Telephone Number	:	216-268-3060
Fax Number	:

Authorized Official
Title or Position	:	OFFICE MANAGEMENT
Name	:	DR. CHAN WANG
Credential	:	DDS
Telephone Number	:	216-268-3060

Provider Enumeration Date	:	04/17/2008
Last Update Date	:	04/17/2008

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