MEDICARE: DR. IAN CANEPA DMD

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	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	30.027042	OH

General Provider Information

NPI Number	:	1811587025
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. IAN CANEPA DMD

Provider Business Mailing Address
First Line	:	10900 EUCLID AVE
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44106-1712
Country	:	US
Telephone Number	:	216-368-3249
Fax Number	:

Provider Business Practice Location Address
First Line	:	10900 EUCLID AVE
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44106-1712
Country	:	US
Telephone Number	:	216-368-3249
Fax Number	:

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

Provider Enumeration Date	:	01/21/2021
Last Update Date	:	12/16/2025

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