MEDICARE: BADGER CENTER FOR MODERN DENTISTRY, PA

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	DN13942	FL

General Provider Information

NPI Number	:	1609835453
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BADGER CENTER FOR MODERN DENTISTRY, PA

Provider Business Mailing Address
First Line	:	7009 DR PHILLIPS BLVD
Second Line	:	SUITE 200
City	:	ORLANDO
State	:	FL
Zip	:	32819-5101
Country	:	US
Telephone Number	:	407-370-0200
Fax Number	:	407-370-0277

Provider Business Practice Location Address
First Line	:	7009 DR PHILLIPS BLVD
Second Line	:	SUITE 200
City	:	ORLANDO
State	:	FL
Zip	:	32819-5101
Country	:	US
Telephone Number	:	407-370-0200
Fax Number	:	407-370-0277

Authorized Official
Title or Position	:	PRESIDENT
Name	:	L. MICHAEL BADGER
Credential	:
Telephone Number	:	407-370-0200

Provider Enumeration Date	:	03/21/2006
Last Update Date	:	08/22/2020

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