MEDICARE: DR. JOSE VIANA PAIVA JR. 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
1	1223P0700X	Prosthodontics	DN18971	FL
2	1223G0001X	General Practice Dentistry	DN18971	FL

General Provider Information

NPI Number	:	1104066448
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOSE VIANA PAIVA JR. D.D.S

Provider Business Mailing Address
First Line	:	2309A SAINT ANDREWS BLVD
Second Line	:
City	:	PANAMA CITY
State	:	FL
Zip	:	32405-2173
Country	:	US
Telephone Number	:	850-763-5858
Fax Number	:	850-763-7125

Provider Business Practice Location Address
First Line	:	2309A SAINT ANDREWS BLVD
Second Line	:
City	:	PANAMA CITY
State	:	FL
Zip	:	32405-2173
Country	:	US
Telephone Number	:	850-763-5858
Fax Number	:

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

Provider Enumeration Date	:	02/26/2009
Last Update Date	:	04/18/2019

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