MEDICARE: PLAZA DOWNTOWN DENTAL, P.A.

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	FL6106	FL

General Provider Information

NPI Number	:	1831385145
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PLAZA DOWNTOWN DENTAL, P.A.

Provider Business Mailing Address
First Line	:	121 S ORANGE AVE
Second Line	:	SUITE 1170N
City	:	ORLANDO
State	:	FL
Zip	:	32801-3221
Country	:	US
Telephone Number	:	407-733-0066
Fax Number	:

Provider Business Practice Location Address
First Line	:	121 S ORANGE AVE
Second Line	:	SUITE 1170N
City	:	ORLANDO
State	:	FL
Zip	:	32801-3221
Country	:	US
Telephone Number	:	407-733-0066
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. KENNETH E PYLE
Credential	:	D.D.S
Telephone Number	:	407-733-0066

Provider Enumeration Date	:	09/20/2007
Last Update Date	:	09/20/2007

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