MEDICARE: JAY DAVID KRASNE 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	DN8891	FL

General Provider Information

NPI Number	:	1093737074
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAY DAVID KRASNE DDS

Provider Business Mailing Address
First Line	:	12208 SNEAD PLACE
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33624
Country	:	US
Telephone Number	:	813-963-1873
Fax Number	:	813-961-6169

Provider Business Practice Location Address
First Line	:	3331 W BEARSS AVENUE
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33618-2100
Country	:	US
Telephone Number	:	813-968-5368
Fax Number	:	813-961-6169

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

Provider Enumeration Date	:	07/25/2006
Last Update Date	:	07/08/2007

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