MEDICARE: DR. DEAN STEVEN EISENBERG DDS

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	30017509	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1396907440
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DEAN STEVEN EISENBERG DDS

Provider Business Mailing Address
First Line	:	6551 WILSON MILLS
Second Line	:	SUITE 102
City	:	MAYFIELD VILLAGE
State	:	OH
Zip	:	44143-3425
Country	:	US
Telephone Number	:	440-684-1133
Fax Number	:	440-684-1199

Provider Business Practice Location Address
First Line	:	6551 WILSON MILLS
Second Line	:	SUITE 102
City	:	MAYFIELD VILLAGE
State	:	OH
Zip	:	44143-3425
Country	:	US
Telephone Number	:	440-684-1133
Fax Number	:	440-684-1199

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

Provider Enumeration Date	:	06/30/2008
Last Update Date	:	06/30/2008

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