MEDICARE: DR. CHRISTOPHER JAMES BEDOYA 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	122300000X	Dentist	22943	FL
2	1223G0001X	General Practice Dentistry	22943	FL

General Provider Information

NPI Number	:	1104350503
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHRISTOPHER JAMES BEDOYA D.D.S.

Provider Business Mailing Address
First Line	:	431 OLYMPUS DR
Second Line	:
City	:	JUNO BEACH
State	:	FL
Zip	:	33408-2309
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6626 HYPOLUXO RD STE A1
Second Line	:
City	:	LAKE WORTH
State	:	FL
Zip	:	33467-7676
Country	:	US
Telephone Number	:	561-433-9600
Fax Number	:

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

Provider Enumeration Date	:	04/12/2017
Last Update Date	:	08/31/2020

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