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NPI Code Detail

MEDICARE: MR. TOUSANT JAMEL PLUNKETT

MEDICARE: MR. TOUSANT JAMEL PLUNKETT
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
11223G0001XGeneral Practice DentistryDN22977FL

General Provider Information

NPI Number : 1245681246
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. TOUSANT JAMEL PLUNKETT
Provider Business Mailing Address
First Line : 1325 TROPICAL DR
Second Line :
City : LAKE WORTH
State : FL
Zip : 33460-5343
Country : US
Telephone Number : 561-317-8195
Fax Number :
Provider Business Practice Location Address
First Line : 1325 TROPICAL DR
Second Line :
City : LAKE WORTH
State : FL
Zip : 33460-5343
Country : US
Telephone Number : 561-317-8195
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/30/2016
Last Update Date : 05/08/2018

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