MEDICARE: FREDERICK THOMAS PALACIOS 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	1223G0001X	General Practice Dentistry	DN20651	FL

General Provider Information

NPI Number	:	1811146806
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	FREDERICK THOMAS PALACIOS D.D.S

Provider Business Mailing Address
First Line	:	531 S CHICKASAW TRL STE 255
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32825-7801
Country	:	US
Telephone Number	:	407-277-3341
Fax Number	:	407-613-5519

Provider Business Practice Location Address
First Line	:	531 S CHICKASAW TRL STE 255
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32825-7801
Country	:	US
Telephone Number	:	407-277-3341
Fax Number	:	407-613-5519

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

Provider Enumeration Date	:	09/15/2008
Last Update Date	:	04/15/2020

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