MEDICARE: DR. PRISCILLA BURT COE 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	1223G0001X	General Practice Dentistry	DN 11576	FL
2	1223G0001X	General Practice Dentistry	5578	NC

General Provider Information

NPI Number	:	1669527222
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PRISCILLA BURT COE DDS

Provider Business Mailing Address
First Line	:	10503 SEVILLA DR
Second Line	:	# 201
City	:	FORT MYERS
State	:	FL
Zip	:	33913-7032
Country	:	US
Telephone Number	:	239-561-5139
Fax Number	:

Provider Business Practice Location Address
First Line	:	3877 TAMIAMI TRL E
Second Line	:
City	:	NAPLES
State	:	FL
Zip	:	34112-6230
Country	:	US
Telephone Number	:	239-774-3545
Fax Number	:	239-774-1540

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

Provider Enumeration Date	:	01/24/2007
Last Update Date	:	07/08/2007

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