MEDICARE: MICHAEL J. SRADOMSKI D.M.D.

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	22530L	PA

General Provider Information

NPI Number	:	1982625729
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL J. SRADOMSKI D.M.D.

Provider Business Mailing Address
First Line	:	1325 FREEDOM RD
Second Line	:
City	:	CRANBERRY TWP
State	:	PA
Zip	:	16066-5001
Country	:	US
Telephone Number	:	724-776-5151
Fax Number	:	724-776-1114

Provider Business Practice Location Address
First Line	:	1325 FREEDOM RD
Second Line	:
City	:	CRANBERRY TWP
State	:	PA
Zip	:	16066-5001
Country	:	US
Telephone Number	:	724-776-5151
Fax Number	:	724-776-1114

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

Provider Enumeration Date	:	07/21/2006
Last Update Date	:	07/08/2007

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