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NPI Code Detail

MEDICARE: EDWARD FLOYD BAINES D.D.S.

MEDICARE: EDWARD FLOYD BAINES D.D.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
11223P0300XPeriodontics5975FL

General Provider Information

NPI Number : 1093961591
Entity Type Code : Individual
Provider Name (Legal Business Name) : EDWARD FLOYD BAINES D.D.S.
Provider Business Mailing Address
First Line : 140 6TH AVE
Second Line :
City : INDIALANTIC
State : FL
Zip : 32903-3204
Country : US
Telephone Number : 321-951-1577
Fax Number :
Provider Business Practice Location Address
First Line : 140 6TH AVE
Second Line :
City : INDIALANTIC
State : FL
Zip : 32903-3204
Country : US
Telephone Number : 321-951-1577
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/15/2008
Last Update Date : 08/15/2008

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