MEDICARE: DR. CHARLES T LIONETTI D.D.S.

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	16549	OH

General Provider Information

NPI Number	:	1518131788
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHARLES T LIONETTI D.D.S.

Provider Business Mailing Address
First Line	:	5510 PEARL RD STE 301
Second Line	:
City	:	PARMA
State	:	OH
Zip	:	44129-2550
Country	:	US
Telephone Number	:	440-845-8700
Fax Number	:

Provider Business Practice Location Address
First Line	:	5510 PEARL RD STE 301
Second Line	:
City	:	PARMA
State	:	OH
Zip	:	44129-2550
Country	:	US
Telephone Number	:	440-845-8700
Fax Number	:

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

Provider Enumeration Date	:	04/17/2008
Last Update Date	:	04/17/2008

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