MEDICARE: MIDDLEBURG HEIGHTS MAGIC DENTISTRY LLC - MICHAEL CRITES 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

General Provider Information

NPI Number	:	1497214381
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MIDDLEBURG HEIGHTS MAGIC DENTISTRY LLC - MICHAEL CRITES DDS

Provider Business Mailing Address
First Line	:	7123 PEARL RD STE 100
Second Line	:
City	:	MIDDLEBURG HEIGHTS
State	:	OH
Zip	:	44130-4944
Country	:	US
Telephone Number	:	216-545-0820
Fax Number	:	216-545-0819

Provider Business Practice Location Address
First Line	:	7123 PEARL RD STE 100
Second Line	:
City	:	MIDDLEBURG HEIGHTS
State	:	OH
Zip	:	44130-4944
Country	:	US
Telephone Number	:	720-934-2442
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	MICHAEL CRITES
Credential	:	DDS
Telephone Number	:	216-545-0820

Provider Enumeration Date	:	03/19/2019
Last Update Date	:	09/04/2019

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