MEDICARE: DR. CARL M PESHOFF 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	1223P0300X	Periodontics	17517	OH

General Provider Information

NPI Number	:	1942395918
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CARL M PESHOFF DDS

Provider Business Mailing Address
First Line	:	2223 FULTON RD NW
Second Line	:
City	:	CANTON
State	:	OH
Zip	:	44709-3554
Country	:	US
Telephone Number	:	330-454-3000
Fax Number	:	330-454-3205

Provider Business Practice Location Address
First Line	:	2223 FULTON RD NW
Second Line	:
City	:	CANTON
State	:	OH
Zip	:	44709-3554
Country	:	US
Telephone Number	:	330-454-3000
Fax Number	:	330-454-3205

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

Provider Enumeration Date	:	10/04/2006
Last Update Date	:	07/08/2007

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