MEDICARE: COSMETIC & NATURAL DENTISTRY, PC

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	:	1558605535
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COSMETIC & NATURAL DENTISTRY, PC

Provider Business Mailing Address
First Line	:	2600 NEWBURG RD
Second Line	:
City	:	EASTON
State	:	PA
Zip	:	18045-1936
Country	:	US
Telephone Number	:	610-252-1454
Fax Number	:

Provider Business Practice Location Address
First Line	:	2600 NEWBURG RD
Second Line	:
City	:	EASTON
State	:	PA
Zip	:	18045-1936
Country	:	US
Telephone Number	:	610-252-1454
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. AUGUST METZ IV
Credential	:	DMD
Telephone Number	:	610-252-1454

Provider Enumeration Date	:	11/15/2012
Last Update Date	:	11/15/2012

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