MEDICARE: HUDEC & ASSOCIATES IN DENTAL CARE 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	:	1922486000
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HUDEC & ASSOCIATES IN DENTAL CARE LLC

Provider Business Mailing Address
First Line	:	5595 TRANSPORTATION BLVD
Second Line	:	SUITE 250
City	:	GARFIELD HTS
State	:	OH
Zip	:	44125-5379
Country	:	US
Telephone Number	:	216-475-0505
Fax Number	:	216-475-9290

Provider Business Practice Location Address
First Line	:	5595 TRANSPORTATION BLVD
Second Line	:	SUITE 250
City	:	GARFIELD HTS
State	:	OH
Zip	:	44125-5379
Country	:	US
Telephone Number	:	216-475-0505
Fax Number	:	216-475-9290

Authorized Official
Title or Position	:	OWNER
Name	:	DAVID E HUDEC JR.
Credential	:	DMD
Telephone Number	:	216-475-0505

Provider Enumeration Date	:	05/11/2015
Last Update Date	:	06/29/2015

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