MEDICARE: DR. JOSEPH EDWARD CILLO JR.

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	1223S0112X	Oral and Maxillofacial Surgery (Dentist)	DS030877L	PA

General Provider Information

NPI Number	:	1932131091
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOSEPH EDWARD CILLO JR.

Provider Business Mailing Address
First Line	:	305 MOUNT LEBANON BLVD
Second Line	:	SUITE 305
City	:	PITTSBURGH
State	:	PA
Zip	:	15234-1511
Country	:	US
Telephone Number	:	412-563-7707
Fax Number	:	412-569-0970

Provider Business Practice Location Address
First Line	:	305 MOUNT LEBANON BLVD
Second Line	:	SUITE 305
City	:	PITTSBURGH
State	:	PA
Zip	:	15234-1511
Country	:	US
Telephone Number	:	412-563-7707
Fax Number	:	412-569-0970

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

Provider Enumeration Date	:	07/07/2006
Last Update Date	:	07/08/2007

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