MEDICARE: DENTAL CARE OF MID FLORIDA

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	12378	FL

General Provider Information

NPI Number	:	1194858159
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DENTAL CARE OF MID FLORIDA

Provider Business Mailing Address
First Line	:	1735 US HIGHWAY 27 S
Second Line	:
City	:	SEBRING
State	:	FL
Zip	:	33870-4920
Country	:	US
Telephone Number	:	863-382-9090
Fax Number	:	863-382-1751

Provider Business Practice Location Address
First Line	:	1735 US HIGHWAY 27 S
Second Line	:
City	:	SEBRING
State	:	FL
Zip	:	33870-4920
Country	:	US
Telephone Number	:	863-382-9090
Fax Number	:	863-382-1751

Authorized Official
Title or Position	:	CO-OWNER
Name	:	RONALD LEWIS OWEN
Credential	:	DDS
Telephone Number	:	863-382-9090

Provider Enumeration Date	:	03/13/2007
Last Update Date	:	12/29/2008

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