MEDICARE: GIRGIS SALEEB 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	DN29424	FL

General Provider Information

NPI Number	:	1659109593
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GIRGIS SALEEB DMD

Provider Business Mailing Address
First Line	:	3135 COLUMBIA BLVD STE 101
Second Line	:
City	:	TITUSVILLE
State	:	FL
Zip	:	32780-7833
Country	:	US
Telephone Number	:	321-567-2000
Fax Number	:

Provider Business Practice Location Address
First Line	:	3135 COLUMBIA BLVD STE 101
Second Line	:
City	:	TITUSVILLE
State	:	FL
Zip	:	32780-7833
Country	:	US
Telephone Number	:	321-567-2000
Fax Number	:

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

Provider Enumeration Date	:	07/23/2024
Last Update Date	:	07/23/2024

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Directions to “ GIRGIS SALEEB DMD” Practice Location

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