MEDICARE: DR. STEPHEN J CWIKLA DMD

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	1223E0200X	Endodontics	DN15896	FL

General Provider Information

NPI Number	:	1376749804
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. STEPHEN J CWIKLA DMD

Provider Business Mailing Address
First Line	:	3670 HENDERSON BLVD STE B
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33609-4515
Country	:	US
Telephone Number	:	813-871-5900
Fax Number	:

Provider Business Practice Location Address
First Line	:	3670 HENDERSON BLVD STE B
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33609-4515
Country	:	US
Telephone Number	:	813-871-5900
Fax Number	:

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

Provider Enumeration Date	:	06/22/2007
Last Update Date	:	07/08/2007

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