MEDICARE: DR. CATHERINE POLEMIS KING DDS

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	DN100820	FL

General Provider Information

NPI Number	:	1548378243
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CATHERINE POLEMIS KING DDS

Provider Business Mailing Address
First Line	:	2531 EDGEWATER DR
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32804-4432
Country	:	US
Telephone Number	:	407-425-0087
Fax Number	:	407-254-4450

Provider Business Practice Location Address
First Line	:	2531 EDGEWATER DR
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32804-4432
Country	:	US
Telephone Number	:	407-425-0087
Fax Number	:	407-254-4450

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

Provider Enumeration Date	:	08/25/2006
Last Update Date	:	07/08/2007

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