MEDICARE: PAOLA R UCEDA DDS PA

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

General Provider Information

NPI Number	:	1245699131
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PAOLA R UCEDA DDS PA

Provider Business Mailing Address
First Line	:	518 EAST BLVD
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28203-5110
Country	:	US
Telephone Number	:	704-332-5848
Fax Number	:	704-332-5817

Provider Business Practice Location Address
First Line	:	518 EAST BLVD
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28203-5110
Country	:	US
Telephone Number	:	704-332-5848
Fax Number	:	704-332-5817

Authorized Official
Title or Position	:	OWNER
Name	:	MRS. PAOLA R UCEDA
Credential	:	DDS
Telephone Number	:	704-332-5848

Provider Enumeration Date	:	02/19/2016
Last Update Date	:	02/19/2016

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