=====================================================
General NPI Number Information
=====================================================
NPI Number | 1982813804
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | WEST FLORIDA ENDODONTICS, PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/21/2007
-----------------------------------------------------
Last Update Date | 05/27/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6111 N DAVIS HWY STE B
-----------------------------------------------------
City | PENSACOLA
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32504-6913
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 850-474-0565
-----------------------------------------------------
Fax | 850-474-0057
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6111 N DAVIS HWY STE B
-----------------------------------------------------
City | PENSACOLA
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32504-6913
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 850-474-0565
-----------------------------------------------------
Fax | 850-474-0057
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. MARK STEVEN DENUNZIO
-----------------------------------------------------
Credential | D.D.S.
-----------------------------------------------------
Telephone | 850-474-0565
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223E0200X
-----------------------------------------------------
Taxonomy Name | Endodontics
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------