MEDICARE: VICTOR MARTIN DUTKO JR. DDS

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	17650	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1811036650
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VICTOR MARTIN DUTKO JR. DDS

Provider Business Mailing Address
First Line	:	2959 CANFIELD RD
Second Line	:	SUITE 14
City	:	YOUNGSTOWN
State	:	OH
Zip	:	44511-2800
Country	:	US
Telephone Number	:	330-799-1216
Fax Number	:	330-799-1526

Provider Business Practice Location Address
First Line	:	2959 CANFIELD RD
Second Line	:	SUITE 14
City	:	YOUNGSTOWN
State	:	OH
Zip	:	44511-2800
Country	:	US
Telephone Number	:	330-799-1216
Fax Number	:	330-799-1526

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

Provider Enumeration Date	:	02/06/2007
Last Update Date	:	07/08/2007

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