MEDICARE: DR. EDWARD CIAS III 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	1223G0001X	General Practice Dentistry	DS036082	PA

General Provider Information

NPI Number	:	1366425738
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. EDWARD CIAS III DMD

Provider Business Mailing Address
First Line	:	58 E WELLSBORO ST
Second Line	:
City	:	MANSFIELD
State	:	PA
Zip	:	16933-1193
Country	:	US
Telephone Number	:	570-662-7779
Fax Number	:

Provider Business Practice Location Address
First Line	:	58 E WELLSBORO ST
Second Line	:
City	:	MANSFIELD
State	:	PA
Zip	:	16933-1193
Country	:	US
Telephone Number	:	570-662-7779
Fax Number	:

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

Provider Enumeration Date	:	11/21/2005
Last Update Date	:	07/08/2007

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