MEDICARE: DR. DAVID A ITKOFF 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	1223P0221X	Pediatric Dentistry	13095	OH

General Provider Information

NPI Number	:	1710011887
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DAVID A ITKOFF D.D.S.

Provider Business Mailing Address
First Line	:	4730 W BROAD ST
Second Line	:	LINCOLN VILLAGE PLAZA
City	:	COLUMBUS
State	:	OH
Zip	:	43228-1613
Country	:	US
Telephone Number	:	614-878-9292
Fax Number	:

Provider Business Practice Location Address
First Line	:	4730 W BROAD ST
Second Line	:	LINCOLN VILLAGE PLAZA
City	:	COLUMBUS
State	:	OH
Zip	:	43228-1613
Country	:	US
Telephone Number	:	614-878-9292
Fax Number	:

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

Provider Enumeration Date	:	03/14/2007
Last Update Date	:	07/08/2007

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