MEDICARE: MICHAEL E. O'LEARY, DDS, 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	122300000X	Dentist

General Provider Information

NPI Number	:	1770754269
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MICHAEL E. O'LEARY, DDS, LLC

Provider Business Mailing Address
First Line	:	13425 DETROIT AVE
Second Line	:
City	:	LAKEWOOD
State	:	OH
Zip	:	44107-4608
Country	:	US
Telephone Number	:	216-226-2344
Fax Number	:

Provider Business Practice Location Address
First Line	:	13425 DETROIT AVE
Second Line	:
City	:	LAKEWOOD
State	:	OH
Zip	:	44107-4608
Country	:	US
Telephone Number	:	216-226-2344
Fax Number	:

Authorized Official
Title or Position	:	OWNER/DENTIST
Name	:	DR. MICHAEL E O'LEARY
Credential	:	D.D.S.
Telephone Number	:	440-333-1177

Provider Enumeration Date	:	03/12/2008
Last Update Date	:	03/12/2008

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