MEDICARE: DR. MICHAEL E CZESCHIN DMD

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	122300000X	Dentist	2016021700	MO

General Provider Information

NPI Number	:	1710548557
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL E CZESCHIN DMD

Provider Business Mailing Address
First Line	:	1501 HAMPTON AVE
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63139-3038
Country	:	US
Telephone Number	:	314-647-2828
Fax Number	:	146-472-7933

Provider Business Practice Location Address
First Line	:	1501 HAMPTON AVE
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63139-3038
Country	:	US
Telephone Number	:	314-647-2828
Fax Number	:	146-472-7933

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

Provider Enumeration Date	:	06/24/2019
Last Update Date	:	06/24/2019

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