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General NPI Number Information
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NPI Number | 1194187005
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Entity Type | Organization
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Legal Business Name | EDWIN JOHN SZCZEPANIK
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Dates
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Enumeration Date | 03/22/2016
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Last Update Date | 03/22/2016
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Provider Practice Location Address
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Address Line | 7758 WALLACE RD STE 3
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City | ORLANDO
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State | FL
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Zip | 32819-7217
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Country | US
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Telephone | 407-352-6888
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Fax | 407-352-0560
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Provider Business Mailing Address
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Address Line | 7758 WALLACE RD STE 3
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City | ORLANDO
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State | FL
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Zip | 32819-7217
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Country | US
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Telephone | 407-352-6888
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Fax | 407-352-0560
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Authorized Official
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Title or Position | OWNER
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Name | EDWIN JOHN SZCZEPANIK
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Credential | DMD
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Telephone | 407-352-6888
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332BC3200X
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Taxonomy Name | Customized Equipment (DME)
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 8437
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License Number State | FL
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