MEDICARE: 3DMD FAMILY DENTISTRY LLC

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

General Provider Information

NPI Number	:	1386450021
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	3DMD FAMILY DENTISTRY LLC

Provider Business Mailing Address
First Line	:	14653 NEWTONMORE LN
Second Line	:
City	:	LAKEWOOD RANCH
State	:	FL
Zip	:	34202-5641
Country	:	US
Telephone Number	:	973-787-4029
Fax Number	:

Provider Business Practice Location Address
First Line	:	560 N WASHINGTON BLVD STE B
Second Line	:
City	:	SARASOTA
State	:	FL
Zip	:	34236-4253
Country	:	US
Telephone Number	:	973-787-4029
Fax Number	:

Authorized Official
Title or Position	:	DENTIST
Name	:	DR. SERGE MOLDAVSKY
Credential	:	DMD
Telephone Number	:	973-787-4029

Provider Enumeration Date	:	12/07/2024
Last Update Date	:	10/17/2025

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