MEDICARE: DR. JONATHAN W PREBLE 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	DN0012540	FL

General Provider Information

NPI Number	:	1932322898
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JONATHAN W PREBLE D.M.D.

Provider Business Mailing Address
First Line	:	499 E CENTRAL PKWY
Second Line	:	SUITE 200
City	:	ALTAMONTE SPRINGS
State	:	FL
Zip	:	32701-3402
Country	:	US
Telephone Number	:	407-831-3959
Fax Number	:	407-831-0751

Provider Business Practice Location Address
First Line	:	499 E CENTRAL PKWY
Second Line	:	SUITE 200
City	:	ALTAMONTE SPRINGS
State	:	FL
Zip	:	32701-3402
Country	:	US
Telephone Number	:	407-831-3959
Fax Number	:	407-831-0751

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

Provider Enumeration Date	:	04/10/2007
Last Update Date	:	07/08/2007

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