MEDICARE: CASE DENTAL MEDICINE SUPPORT SERVICES, LLC.

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	1223S0112X	Oral and Maxillofacial Surgery (Dentist)		OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1104059658
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CASE DENTAL MEDICINE SUPPORT SERVICES, LLC.

Provider Business Mailing Address
First Line	:	P.O. BOX 415
Second Line	:
City	:	CHESTERLAND
State	:	OH
Zip	:	44026-0415
Country	:	US
Telephone Number	:	440-729-3399
Fax Number	:	440-729-6001

Provider Business Practice Location Address
First Line	:	9601 CHESTER AVE
Second Line	:	SUITE 154
City	:	CLEVELAND
State	:	OH
Zip	:	44106-1666
Country	:	US
Telephone Number	:	216-368-3102
Fax Number	:	216-368-4338

Authorized Official
Title or Position	:	DEPARTMENT CHAIR
Name	:	MR. DALE A. BAUR SR.
Credential	:	DDS
Telephone Number	:	216-368-3102

Provider Enumeration Date	:	09/01/2009
Last Update Date	:	06/22/2021

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