MEDICARE: JOITA GHOSH 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	122300000X	Dentist	10351	CT
2	122300000X	Dentist	DN19609	FL

General Provider Information

NPI Number	:	1184930349
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOITA GHOSH D.D.S

Provider Business Mailing Address
First Line	:	12825 CASTLEMAINE DR
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33626-4469
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1502 W FLETCHER AVE STE 117
Second Line	:	KEA SMILE STUDIO
City	:	TAMPA
State	:	FL
Zip	:	33612-3308
Country	:	US
Telephone Number	:	813-968-6100
Fax Number	:

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

Provider Enumeration Date	:	08/26/2010
Last Update Date	:	08/12/2013

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