MEDICARE: DR. SAM J GUARNIERI DMD

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	DN16969	FL

General Provider Information

NPI Number	:	1851418214
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SAM J GUARNIERI DMD

Provider Business Mailing Address
First Line	:	11872 VIA LUCERNA CIR
Second Line	:
City	:	WINDERMERE
State	:	FL
Zip	:	34786-6079
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	949 N 14TH ST
Second Line	:
City	:	LEESBURG
State	:	FL
Zip	:	34748-3838
Country	:	US
Telephone Number	:	352-460-0164
Fax Number	:	352-460-0659

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

Provider Enumeration Date	:	03/23/2007
Last Update Date	:	01/09/2013

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