MEDICARE: DR. LUDMILS ANTONOS JR. 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	1223S0112X	Oral and Maxillofacial Surgery (Dentist)	20342	FL

General Provider Information

NPI Number	:	1083051924
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LUDMILS ANTONOS JR. DMD

Provider Business Mailing Address
First Line	:	13863 FOX GLOVE ST
Second Line	:
City	:	WINTER GARDEN
State	:	FL
Zip	:	34787-4674
Country	:	US
Telephone Number	:	407-435-4535
Fax Number	:

Provider Business Practice Location Address
First Line	:	7352 STONEROCK CIR
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32819-8000
Country	:	US
Telephone Number	:	407-351-0575
Fax Number	:	407-363-6945

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

Provider Enumeration Date	:	06/02/2013
Last Update Date	:	07/21/2022

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