MEDICARE: KELLI ORCUTT DMD

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	1223G0001X	General Practice Dentistry	DN23451	FL

General Provider Information

NPI Number	:	1063907087
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KELLI ORCUTT DMD

Provider Business Mailing Address
First Line	:	4411 SW 72ND TER
Second Line	:
City	:	DAVIE
State	:	FL
Zip	:	33314-3133
Country	:	US
Telephone Number	:	907-687-5861
Fax Number	:

Provider Business Practice Location Address
First Line	:	3230 FORUM BLVD STE 501
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33905-5580
Country	:	US
Telephone Number	:	239-628-1300
Fax Number	:

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

Provider Enumeration Date	:	06/22/2018
Last Update Date	:	06/22/2018

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