MEDICARE: DR. SAMUEL O. DORN D.D.S.

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	1223E0200X	Endodontics	DN 6770	FL

General Provider Information

NPI Number	:	1770594632
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SAMUEL O. DORN D.D.S.

Provider Business Mailing Address
First Line	:	8200 W SUNRISE BLVD
Second Line	:	SUITE B-2
City	:	PLANTATION
State	:	FL
Zip	:	33322-5426
Country	:	US
Telephone Number	:	954-474-8787
Fax Number	:	954-474-1557

Provider Business Practice Location Address
First Line	:	8200 W SUNRISE BLVD
Second Line	:	SUITE B-2
City	:	PLANTATION
State	:	FL
Zip	:	33322-5426
Country	:	US
Telephone Number	:	954-474-8787
Fax Number	:	954-474-1557

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

Provider Enumeration Date	:	08/10/2006
Last Update Date	:	07/08/2007

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