MEDICARE: MEDPLEX DENTAL

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	12133	FL

General Provider Information

NPI Number	:	1144576380
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MEDPLEX DENTAL

Provider Business Mailing Address
First Line	:	7350 SANDLAKE COMMONS BLVD
Second Line	:	STE. 1121
City	:	ORLANDO
State	:	FL
Zip	:	32819-8040
Country	:	US
Telephone Number	:	407-351-2245
Fax Number	:

Provider Business Practice Location Address
First Line	:	7350 SANDLAKE COMMONS BLVD
Second Line	:	STE. 1121
City	:	ORLANDO
State	:	FL
Zip	:	32819-8040
Country	:	US
Telephone Number	:	407-351-2245
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. MATILDE F CASTELLINI
Credential	:	DDS
Telephone Number	:	407-351-2245

Provider Enumeration Date	:	07/25/2012
Last Update Date	:	07/25/2012

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Directions to “MEDPLEX DENTAL ” Practice Location

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