MEDICARE: DR. JAMES PAUL ANNICCHIARICO 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	050880	NY
2	122300000X	Dentist	DN16509	FL

General Provider Information

NPI Number	:	1790839025
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JAMES PAUL ANNICCHIARICO DDS

Provider Business Mailing Address
First Line	:	4425 ROWAN RD
Second Line	:
City	:	NEW PORT RICHEY
State	:	FL
Zip	:	34653-6198
Country	:	US
Telephone Number	:	727-834-8885
Fax Number	:	727-372-9455

Provider Business Practice Location Address
First Line	:	4425 ROWAN RD
Second Line	:
City	:	NEW PORT RICHEY
State	:	FL
Zip	:	34653-6198
Country	:	US
Telephone Number	:	727-834-8885
Fax Number	:	727-372-9455

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

Provider Enumeration Date	:	01/23/2007
Last Update Date	:	09/01/2009

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