MEDICARE: DR. ANDREW DANCZAK D.M.D

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	057670-1	NY
2	122300000X	Dentist	30.024686	OH

General Provider Information

NPI Number	:	1730571043
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANDREW DANCZAK D.M.D

Provider Business Mailing Address
First Line	:	16606 ERNEST AVE
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44111-5739
Country	:	US
Telephone Number	:	216-280-1600
Fax Number	:

Provider Business Practice Location Address
First Line	:	4163 PEARL RD
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44109-3332
Country	:	US
Telephone Number	:	216-280-1600
Fax Number	:

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

Provider Enumeration Date	:	02/23/2015
Last Update Date	:	09/10/2018

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