MEDICARE: LEONE M PULLELLA 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	OH-017964	OH

General Provider Information

NPI Number	:	1104031624
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LEONE M PULLELLA D.D.S.

Provider Business Mailing Address
First Line	:	3681 GREEN RD
Second Line	:	400
City	:	BEACHWOOD
State	:	OH
Zip	:	44122-5726
Country	:	US
Telephone Number	:	216-464-7850
Fax Number	:	216-464-7434

Provider Business Practice Location Address
First Line	:	3681 GREEN RD
Second Line	:	400
City	:	BEACHWOOD
State	:	OH
Zip	:	44122-5726
Country	:	US
Telephone Number	:	216-464-7850
Fax Number	:	216-464-7434

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

Provider Enumeration Date	:	05/10/2007
Last Update Date	:	07/08/2007

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Directions to “ LEONE M PULLELLA D.D.S.” Practice Location

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