MEDICARE: BERTRAND SOREL DMD, M.D.

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	1223S0112X	Oral and Maxillofacial Surgery (Dentist)	DN15744	FL

General Provider Information

NPI Number	:	1508885591
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BERTRAND SOREL DMD, M.D.

Provider Business Mailing Address
First Line	:	1203 SW SUNSET TRL
Second Line	:
City	:	PALM CITY
State	:	FL
Zip	:	34990-3342
Country	:	US
Telephone Number	:	772-219-9979
Fax Number	:	772-219-9975

Provider Business Practice Location Address
First Line	:	1203 SW SUNSET TRL
Second Line	:
City	:	PALM CITY
State	:	FL
Zip	:	34990-3342
Country	:	US
Telephone Number	:	772-219-9979
Fax Number	:	772-219-9975

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

Provider Enumeration Date	:	07/19/2006
Last Update Date	:	07/08/2007

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