MEDICARE: ANNA B VISGER DDS

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	300-20210	OH

General Provider Information

NPI Number	:	1710032347
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANNA B VISGER DDS

Provider Business Mailing Address
First Line	:	7553 CENTER ST
Second Line	:
City	:	MENTOR
State	:	OH
Zip	:	44060-6001
Country	:	US
Telephone Number	:	440-255-2600
Fax Number	:	440-255-0162

Provider Business Practice Location Address
First Line	:	7553 CENTER ST
Second Line	:
City	:	MENTOR
State	:	OH
Zip	:	44060-6001
Country	:	US
Telephone Number	:	440-255-2600
Fax Number	:	440-255-0162

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

Provider Enumeration Date	:	01/24/2007
Last Update Date	:	07/08/2007

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