MEDICARE: DR. STACEY KNELLINGER VERKLER

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	122300000X	Dentist	DN18261	FL

General Provider Information

NPI Number	:	1043479546
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. STACEY KNELLINGER VERKLER

Provider Business Mailing Address
First Line	:	1246 FLORIDA AVE
Second Line	:
City	:	PALM HARBOR
State	:	FL
Zip	:	34683-4316
Country	:	US
Telephone Number	:	727-785-3383
Fax Number	:	727-785-3378

Provider Business Practice Location Address
First Line	:	1246 FLORIDA AVE
Second Line	:
City	:	PALM HARBOR
State	:	FL
Zip	:	34683-4316
Country	:	US
Telephone Number	:	727-785-3383
Fax Number	:	727-785-3378

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

Provider Enumeration Date	:	06/09/2008
Last Update Date	:	06/09/2008

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