MEDICARE: DENTAL ASSOCIATES

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	FL5865	FL

General Provider Information

NPI Number	:	1982897633
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DENTAL ASSOCIATES

Provider Business Mailing Address
First Line	:	4850 1ST AV N
Second Line	:
City	:	ST PETERSBURG
State	:	FL
Zip	:	33713-8108
Country	:	US
Telephone Number	:	727-321-4850
Fax Number	:	727-323-1679

Provider Business Practice Location Address
First Line	:	4850 1ST AV N
Second Line	:
City	:	ST PETERSBURG
State	:	FL
Zip	:	33713-8108
Country	:	US
Telephone Number	:	727-321-4850
Fax Number	:	727-323-1679

Authorized Official
Title or Position	:	OWNER
Name	:	WAYNE H KEHM
Credential	:	DDS PA
Telephone Number	:	727-321-4850

Provider Enumeration Date	:	08/24/2007
Last Update Date	:	08/24/2007

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Directions to “DENTAL ASSOCIATES ” Practice Location

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