MEDICARE: JOHN A HUDEC PURITAS 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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1619909371
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JOHN A HUDEC PURITAS DENTAL ASSOCIATES INC

Provider Business Mailing Address
First Line	:	14601 PURITAS AVE
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44135-2815
Country	:	US
Telephone Number	:	216-671-5452
Fax Number	:	216-671-5455

Provider Business Practice Location Address
First Line	:	14601 PURITAS AVE
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44135-2815
Country	:	US
Telephone Number	:	216-671-5452
Fax Number	:	216-671-5455

Authorized Official
Title or Position	:	PRESIDENT
Name	:	JOHN A HUDEC
Credential	:	DDS
Telephone Number	:	216-398-8900

Provider Enumeration Date	:	07/06/2006
Last Update Date	:	10/11/2007

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