MEDICARE: DR ROBERT DIBAUDA 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	261QD0000X	Dental Clinic/Center

General Provider Information

NPI Number	:	1144744137
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DR ROBERT DIBAUDA INC

Provider Business Mailing Address
First Line	:	34501 AURORA RD STE 208
Second Line	:
City	:	SOLON
State	:	OH
Zip	:	44139-3831
Country	:	US
Telephone Number	:	440-349-3844
Fax Number	:	440-349-3869

Provider Business Practice Location Address
First Line	:	34501 AURORA RD STE 208
Second Line	:
City	:	SOLON
State	:	OH
Zip	:	44139-3831
Country	:	US
Telephone Number	:	440-349-3844
Fax Number	:	440-349-3869

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. ROBERT DIBAUDA
Credential	:	DDS
Telephone Number	:	440-349-3844

Provider Enumeration Date	:	08/01/2017
Last Update Date	:	08/01/2017

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