MEDICARE: DR. GERARD J LEMONGELLO 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	1223G0001X	General Practice Dentistry	DN11303	FL

General Provider Information

NPI Number	:	1124325055
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GERARD J LEMONGELLO JR. DMD

Provider Business Mailing Address
First Line	:	5602 PGA BLVD
Second Line	:	SUITE 201
City	:	PALM BEACH GARDENS
State	:	FL
Zip	:	33418-3829
Country	:	US
Telephone Number	:	561-627-9000
Fax Number	:	561-627-9162

Provider Business Practice Location Address
First Line	:	5602 PGA BLVD
Second Line	:	SUITE 201
City	:	PALM BEACH GARDENS
State	:	FL
Zip	:	33418-3829
Country	:	US
Telephone Number	:	561-627-9000
Fax Number	:	561-627-9162

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

Provider Enumeration Date	:	02/11/2011
Last Update Date	:	02/11/2011

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