MEDICARE: SEBRING MODERN DENTISTS, PLLC

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	261QD0000X	Dental Clinic/Center

General Provider Information

NPI Number	:	1437876976
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SEBRING MODERN DENTISTS, PLLC

Provider Business Mailing Address
First Line	:	8794 W BOYNTON BEACH BLVD STE 218
Second Line	:
City	:	BOYNTON BEACH
State	:	FL
Zip	:	33472-4469
Country	:	US
Telephone Number	:	561-789-6611
Fax Number	:

Provider Business Practice Location Address
First Line	:	261 US HIGHWAY 27 N
Second Line	:
City	:	SEBRING
State	:	FL
Zip	:	33870-2146
Country	:	US
Telephone Number	:	863-382-2816
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. SEAN TOMALTY
Credential	:	DMD
Telephone Number	:	561-789-6611

Provider Enumeration Date	:	10/25/2022
Last Update Date	:	01/25/2023

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