MEDICARE: MARAT M KOYFMAN DMD PA

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	DN16183	FL

General Provider Information

NPI Number	:	1023102134
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MARAT M KOYFMAN DMD PA

Provider Business Mailing Address
First Line	:	1525 W COLONIAL DR
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32804-7120
Country	:	US
Telephone Number	:	407-841-9435
Fax Number	:	407-423-7889

Provider Business Practice Location Address
First Line	:	1525 W COLONIAL DR
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32804-7120
Country	:	US
Telephone Number	:	407-841-9435
Fax Number	:	407-423-7889

Authorized Official
Title or Position	:	OWNER PRESIDENT
Name	:	MARAT MICHAEL KOYFMAN
Credential	:	DMD
Telephone Number	:	407-841-9435

Provider Enumeration Date	:	10/03/2006
Last Update Date	:	08/22/2020

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