MEDICARE: DR. JAMES J CERMAK 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	18115	OH

General Provider Information

NPI Number	:	1093928251
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JAMES J CERMAK D.D.S

Provider Business Mailing Address
First Line	:	5035 MAYFIELD RD
Second Line	:	SUITE 211
City	:	LYNDHURST
State	:	OH
Zip	:	44124-2688
Country	:	US
Telephone Number	:	216-381-4061
Fax Number	:

Provider Business Practice Location Address
First Line	:	5035 MAYFIELD RD
Second Line	:	SUITE 211
City	:	LYNDHURST
State	:	OH
Zip	:	44124-2688
Country	:	US
Telephone Number	:	216-381-4061
Fax Number	:

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

Provider Enumeration Date	:	05/07/2007
Last Update Date	:	07/08/2007

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