MEDICARE: LEONARD A DAVIDSON DDS FAGD

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	17215	OH

General Provider Information

NPI Number	:	1609931922
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LEONARD A DAVIDSON DDS FAGD

Provider Business Mailing Address
First Line	:	7172 COLUMBIA RD
Second Line	:
City	:	OLMSTED FALLS
State	:	OH
Zip	:	44138-1530
Country	:	US
Telephone Number	:	440-235-3060
Fax Number	:	440-235-2382

Provider Business Practice Location Address
First Line	:	7172 COLUMBIA RD
Second Line	:
City	:	OLMSTED FALLS
State	:	OH
Zip	:	44138-1530
Country	:	US
Telephone Number	:	440-235-3060
Fax Number	:	440-235-2382

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

Provider Enumeration Date	:	12/27/2006
Last Update Date	:	07/08/2007

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