MEDICARE: LEONARD C SEDON D.D.S., M.A.G.D.

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	14986	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	446646	OTHER	OH	TRICARE

General Provider Information

NPI Number	:	1396740809
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LEONARD C SEDON D.D.S., M.A.G.D.

Provider Business Mailing Address
First Line	:	4141 MARTINDALE RD NE
Second Line	:
City	:	CANTON
State	:	OH
Zip	:	44705-2727
Country	:	US
Telephone Number	:	330-493-0300
Fax Number	:	330-493-3435

Provider Business Practice Location Address
First Line	:	4141 MARTINDALE RD NE
Second Line	:
City	:	CANTON
State	:	OH
Zip	:	44705-2727
Country	:	US
Telephone Number	:	330-493-0300
Fax Number	:	330-493-3435

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

Provider Enumeration Date	:	06/21/2005
Last Update Date	:	07/08/2007

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