MEDICARE: DR. BRAD W ARENZ 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	122300000X	Dentist	6712	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	66094	OTHER	FL	BCBS INSURANCE CO

General Provider Information

NPI Number	:	1649328063
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BRAD W ARENZ DMD

Provider Business Mailing Address
First Line	:	3221 S CONWAY RD
Second Line	:	STE B
City	:	ORLANDO
State	:	FL
Zip	:	32812-7363
Country	:	US
Telephone Number	:	407-273-1469
Fax Number	:	407-273-6298

Provider Business Practice Location Address
First Line	:	3221 S CONWAY RD
Second Line	:	STE B
City	:	ORLANDO
State	:	FL
Zip	:	32812-7363
Country	:	US
Telephone Number	:	407-273-1469
Fax Number	:	407-273-6298

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

Provider Enumeration Date	:	01/08/2007
Last Update Date	:	07/08/2007

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