MEDICARE: DR. MARK LOUIS VOLTAREL D.M.D.

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 12808	FL

General Provider Information

NPI Number	:	1811916539
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARK LOUIS VOLTAREL D.M.D.

Provider Business Mailing Address
First Line	:	751 HARLEY STRICKLAND BLVD
Second Line	:
City	:	ORANGE CITY
State	:	FL
Zip	:	32763-7947
Country	:	US
Telephone Number	:	386-774-4777
Fax Number	:	386-774-1996

Provider Business Practice Location Address
First Line	:	751 HARLEY STRICKLAND BLVD
Second Line	:
City	:	ORANGE CITY
State	:	FL
Zip	:	32763-7947
Country	:	US
Telephone Number	:	386-774-4777
Fax Number	:	386-774-1996

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

Provider Enumeration Date	:	07/19/2006
Last Update Date	:	07/08/2007

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