MEDICARE: DR. EMESE TOKOS DDS, 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	1223G0001X	General Practice Dentistry	DEN.00202456	CO
2	1223G0001X	General Practice Dentistry	DEN-DEN-LIC-11462	MT
3	122300000X	Dentist	27479	FL

General Provider Information

NPI Number	:	1588059323
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. EMESE TOKOS DDS, DMD

Provider Business Mailing Address
First Line	:	PO BOX 478
Second Line	:
City	:	SOUTH FORK
State	:	CO
Zip	:	81154-0478
Country	:	US
Telephone Number	:	708-860-8018
Fax Number	:

Provider Business Practice Location Address
First Line	:	1735 US 27 S
Second Line	:
City	:	SEBRING
State	:	FL
Zip	:	33870-4920
Country	:	US
Telephone Number	:	863-382-9090
Fax Number	:

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

Provider Enumeration Date	:	03/30/2015
Last Update Date	:	10/25/2022

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