MEDICARE: DR. JEREMY MATTHEW ALBERT D.M.D., M.S.

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	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	DN 15360	FL

General Provider Information

NPI Number	:	1033318688
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JEREMY MATTHEW ALBERT D.M.D., M.S.

Provider Business Mailing Address
First Line	:	1248 SEVEN SPRINGS BLVD STE B
Second Line	:
City	:	NEW PORT RICHEY
State	:	FL
Zip	:	34655-5652
Country	:	US
Telephone Number	:	727-376-2770
Fax Number	:	727-375-5370

Provider Business Practice Location Address
First Line	:	1806 SHORT BRANCH DR STE 102
Second Line	:
City	:	NEW PORT RICHEY
State	:	FL
Zip	:	34655
Country	:	US
Telephone Number	:	727-376-2770
Fax Number	:	727-375-5370

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

Provider Enumeration Date	:	07/13/2007
Last Update Date	:	07/13/2007

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