MEDICARE: DENTAL CARE DELIVERED

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	122300000X	Dentist	DN014899	FL

General Provider Information

NPI Number	:	1881954998
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DENTAL CARE DELIVERED

Provider Business Mailing Address
First Line	:	1214 PLAYMOOR DR
Second Line	:
City	:	PALM HARBOR
State	:	FL
Zip	:	34683-1471
Country	:	US
Telephone Number	:	727-422-2801
Fax Number	:	727-945-9661

Provider Business Practice Location Address
First Line	:	1214 PLAYMOOR DR
Second Line	:
City	:	PALM HARBOR
State	:	FL
Zip	:	34683-1471
Country	:	US
Telephone Number	:	727-422-2801
Fax Number	:	727-945-9661

Authorized Official
Title or Position	:	OWNER/FOUNDER
Name	:	DR. VINCENT JOSEPH MONTICCIOLO
Credential	:	DDS,MBA
Telephone Number	:	727-422-2801

Provider Enumeration Date	:	05/22/2012
Last Update Date	:	05/22/2012

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Directions to “DENTAL CARE DELIVERED ” Practice Location

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