MEDICARE: TREVISANI ORAL SURGERY

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	261QS0112X	Oral and Maxillofacial Surgery Clinic/Center	DN13576	FL

General Provider Information

NPI Number	:	1053687640
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TREVISANI ORAL SURGERY

Provider Business Mailing Address
First Line	:	2574 S VOLUSIA AVE
Second Line	:
City	:	ORANGE CITY
State	:	FL
Zip	:	32763-9123
Country	:	US
Telephone Number	:	386-774-2999
Fax Number	:	386-774-4922

Provider Business Practice Location Address
First Line	:	2574 S VOLUSIA AVE
Second Line	:
City	:	ORANGE CITY
State	:	FL
Zip	:	32763-9123
Country	:	US
Telephone Number	:	386-774-2999
Fax Number	:	386-774-4922

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MRS. TAMMY EAGLE
Credential	:
Telephone Number	:	407-886-2050

Provider Enumeration Date	:	03/28/2012
Last Update Date	:	03/28/2012

Similar Medicare Providers

1174798433 — ORANGE COUNTY NEWBORN MEDICARE CARE PC
Practice Location Address:

3 SAINT STEPHENS PL , SUITE 2
WARWICK, NY
10990-3208

Practice Phone: 845-987-9700
Practice Fax:

1598866717 — UZMA AHMED KHURSHID MD
Practice Location Address:

2574 S VOLUSIA AVE
ORANGE CITY, FL
32763-9123

Practice Phone: 386-775-1086
Practice Fax: 386-775-8990

1164782637 — SAXON INTERNAL MEDICINE P A
Practice Location Address:

2574 S VOLUSIA AVE
ORANGE CITY, FL
32763-9123

Practice Phone: 386-775-1086
Practice Fax: 386-775-8990

1598421521 — MELISSA GOUCHENOUER FNP
Practice Location Address:

2574 S VOLUSIA AVE
ORANGE CITY, FL
32763-9123

Practice Phone: 386-775-1086
Practice Fax:

1467382317 — HONAR SALEH
Practice Location Address:

3699 HWAY 95 STE 316B
BULLHEAD CITY, AZ
86442-9123

Practice Phone: 928-955-4053
Practice Fax:

1184338725 — AFFORDABLE DENTURES & IMPLANTS - BULLHEAD CITY V, P.C.
Practice Location Address:

3699 HIGHWAY 95 STE 316B
BULLHEAD CITY, AZ
86442-9123

Practice Phone: 928-704-9242
Practice Fax:

Directions to “TREVISANI ORAL SURGERY ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.