MEDICARE: CANTON SOUTH DENTAL, COOK, ROTOLO & EARICH, LLC

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

General Provider Information

NPI Number	:	1740156819
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CANTON SOUTH DENTAL, COOK, ROTOLO & EARICH, LLC

Provider Business Mailing Address
First Line	:	3702 CLEVELAND AVE S
Second Line	:
City	:	CANTON
State	:	OH
Zip	:	44707-1450
Country	:	US
Telephone Number	:	330-484-6401
Fax Number	:

Provider Business Practice Location Address
First Line	:	3702 CLEVELAND AVE S
Second Line	:
City	:	CANTON
State	:	OH
Zip	:	44707-1450
Country	:	US
Telephone Number	:	330-484-6401
Fax Number	:

Authorized Official
Title or Position	:	CO-OWNER/DENTIST
Name	:	DR. MATTHEW JAMES EARICH
Credential	:	DMD
Telephone Number	:	330-484-6401

Provider Enumeration Date	:	10/15/2025
Last Update Date	:	10/15/2025

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