MEDICARE: DR. JAMES F MUNGO 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	13537	OH

General Provider Information

NPI Number	:	1245235241
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JAMES F MUNGO D.D.S.

Provider Business Mailing Address
First Line	:	905 ROBINWOOD HILLS DRIVE
Second Line	:
City	:	AKRON
State	:	OH
Zip	:	44333
Country	:	US
Telephone Number	:	330-666-5054
Fax Number	:

Provider Business Practice Location Address
First Line	:	544 WHITE POND DR
Second Line	:	STE C
City	:	AKRON
State	:	OH
Zip	:	44320-1141
Country	:	US
Telephone Number	:	330-836-9818
Fax Number	:

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

Provider Enumeration Date	:	06/16/2005
Last Update Date	:	07/08/2007

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