MEDICARE: MR. JOHN S LEDAKIS DDS

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	10095	FL

General Provider Information

NPI Number	:	1023092087
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JOHN S LEDAKIS DDS

Provider Business Mailing Address
First Line	:	4512 N FLAGLER DRIVE
Second Line	:	STE 301
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33407
Country	:	US
Telephone Number	:	561-863-9884
Fax Number	:	561-848-7040

Provider Business Practice Location Address
First Line	:	4512 N FLAGLER DRIVE
Second Line	:	STE 301
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33407
Country	:	US
Telephone Number	:	561-863-9884
Fax Number	:	561-848-7040

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

Provider Enumeration Date	:	12/02/2005
Last Update Date	:	07/08/2007

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