MEDICARE: DR. GRETCHEN B JUNGERMANN DMD, MS

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	14871	FL
2	1223E0200X	Endodontics	DN147871	FL
3	1223E0200X	Endodontics	DN14871	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1285693259
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GRETCHEN B JUNGERMANN DMD, MS

Provider Business Mailing Address
First Line	:	1110 W WINGED FOOT CIR
Second Line	:
City	:	WINTER SPRINGS
State	:	FL
Zip	:	32708-4203
Country	:	US
Telephone Number	:	239-908-1000
Fax Number	:

Provider Business Practice Location Address
First Line	:	1148 PELICAN BAY DR
Second Line	:
City	:	DAYTONA BEACH
State	:	FL
Zip	:	32119-1381
Country	:	US
Telephone Number	:	386-256-2513
Fax Number	:

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

Provider Enumeration Date	:	03/20/2006
Last Update Date	:	01/19/2023

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