MEDICARE: DENTALAND, FT PIERCE

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	DN5487	FL

General Provider Information

NPI Number	:	1023250255
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DENTALAND, FT PIERCE

Provider Business Mailing Address
First Line	:	3230 W COMMERCIAL BLVD
Second Line	:	SUITE 190
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33309-3429
Country	:	US
Telephone Number	:	954-719-4420
Fax Number	:	954-678-9539

Provider Business Practice Location Address
First Line	:	2505 S FEDERAL HWY
Second Line	:	SABAL PALM PLAZA
City	:	FORT PIERCE
State	:	FL
Zip	:	34982-5922
Country	:	US
Telephone Number	:	772-464-4646
Fax Number	:	772-460-9967

Authorized Official
Title or Position	:	CEO
Name	:	DR. JEFFREY FEINGOLD
Credential	:	DDS
Telephone Number	:	954-719-4420

Provider Enumeration Date	:	04/02/2009
Last Update Date	:	04/02/2009

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