MEDICARE: DR. WARREN ROBERT GASE DDS, MAGD, 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	1223G0001X	General Practice Dentistry	17737	OH

General Provider Information

NPI Number	:	1992700447
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. WARREN ROBERT GASE DDS, MAGD, INC

Provider Business Mailing Address
First Line	:	9294 WINTON RD
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45231-3936
Country	:	US
Telephone Number	:	513-931-3001
Fax Number	:	513-931-0027

Provider Business Practice Location Address
First Line	:	9294 WINTON RD
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45231-3936
Country	:	US
Telephone Number	:	513-931-3001
Fax Number	:	513-931-0027

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

Provider Enumeration Date	:	06/20/2005
Last Update Date	:	06/03/2015

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