MEDICARE: DR. LEO S SAUCER 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	2901012038	MI

General Provider Information

NPI Number	:	1184799314
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LEO S SAUCER D.D.S.

Provider Business Mailing Address
First Line	:	870 UNION ST
Second Line	:
City	:	BENTON HARBOR
State	:	MI
Zip	:	49022-4819
Country	:	US
Telephone Number	:	269-925-8691
Fax Number	:

Provider Business Practice Location Address
First Line	:	870 UNION ST
Second Line	:
City	:	BENTON HARBOR
State	:	MI
Zip	:	49022-4819
Country	:	US
Telephone Number	:	269-925-8691
Fax Number	:

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

Provider Enumeration Date	:	11/22/2006
Last Update Date	:	07/08/2007

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