MEDICARE: DR. MARIE ANTONETTE ALBANO 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	122300000X	Dentist	30016384	OH

General Provider Information

NPI Number	:	1477557197
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARIE ANTONETTE ALBANO DDS

Provider Business Mailing Address
First Line	:	14601 DETROIT AVE
Second Line	:	STE 680
City	:	LAKEWOOD
State	:	OH
Zip	:	44107-4251
Country	:	US
Telephone Number	:	216-529-7181
Fax Number	:	216-529-1356

Provider Business Practice Location Address
First Line	:	14601 DETROIT AVE
Second Line	:	STE 680
City	:	LAKEWOOD
State	:	OH
Zip	:	44107-4251
Country	:	US
Telephone Number	:	216-529-7181
Fax Number	:	216-529-1356

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

Provider Enumeration Date	:	06/09/2005
Last Update Date	:	07/08/2007

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