MEDICARE: DR. LORA ELIAS DMD

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	122300000X	Dentist	19245	OH

General Provider Information

NPI Number	:	1356475446
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LORA ELIAS DMD

Provider Business Mailing Address
First Line	:	5325 FLEET AVE
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44105-3335
Country	:	US
Telephone Number	:	216-641-0053
Fax Number	:

Provider Business Practice Location Address
First Line	:	5325 FLEET AVE
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44105-3335
Country	:	US
Telephone Number	:	216-641-0053
Fax Number	:

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

Provider Enumeration Date	:	03/14/2007
Last Update Date	:	07/08/2007

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