MEDICARE: MCD DENTISTRY, PA

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	DN19664	FL

General Provider Information

NPI Number	:	1831446376
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MCD DENTISTRY, PA

Provider Business Mailing Address
First Line	:	PO BOX 3189
Second Line	:
City	:	SYRACUSE
State	:	NY
Zip	:	13220-3189
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	12813 N DALE MABRY HWY
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33618-2803
Country	:	US
Telephone Number	:	813-962-1400
Fax Number	:

Authorized Official
Title or Position	:	PROVIDER RELATIONS MANAGER
Name	:	ASHLEY COLE
Credential	:
Telephone Number	:	866-273-8204

Provider Enumeration Date	:	08/14/2012
Last Update Date	:	08/14/2012

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Directions to “MCD DENTISTRY, PA ” Practice Location

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