MEDICARE: HUDEC DENTAL ASSOCIATES, 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	30-015265	OH

General Provider Information

NPI Number	:	1154494680
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HUDEC DENTAL ASSOCIATES, INC.

Provider Business Mailing Address
First Line	:	3327 BROADVIEW RD
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44109-3315
Country	:	US
Telephone Number	:	216-485-5788
Fax Number	:	216-485-1257

Provider Business Practice Location Address
First Line	:	8191 BROADVIEW RD
Second Line	:
City	:	BROADVIEW HEIGHTS
State	:	OH
Zip	:	44147-1661
Country	:	US
Telephone Number	:	440-526-5650
Fax Number	:	440-526-5165

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. JOHN A. HUDEC
Credential	:	D.D.S.
Telephone Number	:	216-485-5788

Provider Enumeration Date	:	11/15/2006
Last Update Date	:	10/11/2007

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