MEDICARE: KIRERU DENTAL ASSOCIATES INC

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	23631	OH

General Provider Information

NPI Number	:	1528491982
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KIRERU DENTAL ASSOCIATES INC

Provider Business Mailing Address
First Line	:	PO BOX 3189
Second Line	:
City	:	SYRACUSE
State	:	NY
Zip	:	13220-3189
Country	:	US
Telephone Number	:	315-454-6000
Fax Number	:

Provider Business Practice Location Address
First Line	:	6218 GLENWAY AVE
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45211-6314
Country	:	US
Telephone Number	:	513-245-8460
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MARTIN KIRERU
Credential	:
Telephone Number	:	513-245-8460

Provider Enumeration Date	:	08/20/2013
Last Update Date	:	08/20/2013

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