MEDICARE: ANDREW J DEAK & ASSOCIATES INC

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	022343	OH
2	1223G0001X	General Practice Dentistry	022513	OH

General Provider Information

NPI Number	:	1760745756
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ANDREW J DEAK & ASSOCIATES INC

Provider Business Mailing Address
First Line	:	19657 HILLIARD BLVD
Second Line	:
City	:	ROCKY RIVER
State	:	OH
Zip	:	44116-2926
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3730 ROCKY RIVER DR
Second Line	:	SUITE 1
City	:	CLEVELAND
State	:	OH
Zip	:	44111-4044
Country	:	US
Telephone Number	:	216-251-8787
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. ANDREW JUSTEN DEAK
Credential	:	MD, DMD
Telephone Number	:	440-667-2224

Provider Enumeration Date	:	06/24/2012
Last Update Date	:	06/24/2012

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