MEDICARE: DR. PEDRO ANIBAL BELAUNZARAN D.D.S

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	DN0013554	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	42014	OTHER	FL	ATLANTIC DENTAL INSURANCE
2	3663	OTHER	FL	COMPBENEFITS

General Provider Information

NPI Number	:	1164513610
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PEDRO ANIBAL BELAUNZARAN D.D.S

Provider Business Mailing Address
First Line	:	8130 W WATERS AVE STE 200B
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33615-1855
Country	:	US
Telephone Number	:	813-243-4142
Fax Number	:	813-886-1660

Provider Business Practice Location Address
First Line	:	8130 W WATERS AVE STE 200B
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33615-1855
Country	:	US
Telephone Number	:	813-243-4142
Fax Number	:	813-886-1660

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

Provider Enumeration Date	:	09/28/2006
Last Update Date	:	07/08/2007

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