MEDICARE: DR. ELVIRA CHICCARELLI 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	1223G0001X	General Practice Dentistry	DN7555	FL

General Provider Information

NPI Number	:	1134292162
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ELVIRA CHICCARELLI DDS

Provider Business Mailing Address
First Line	:	110 LOGAN LN STE 5
Second Line	:
City	:	SANTA ROSA BEACH
State	:	FL
Zip	:	32459-5780
Country	:	US
Telephone Number	:	850-321-0321
Fax Number	:

Provider Business Practice Location Address
First Line	:	110 LOGAN LN STE 5
Second Line	:
City	:	SANTA ROSA BEACH
State	:	FL
Zip	:	32459-5780
Country	:	US
Telephone Number	:	850-321-0321
Fax Number	:

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

Provider Enumeration Date	:	11/16/2006
Last Update Date	:	07/08/2007

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