MEDICARE: DR. NATALIE CARR BUSTILLO DDS, MS

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	1223P0221X	Pediatric Dentistry	DN15116	FL

General Provider Information

NPI Number	:	1134283880
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NATALIE CARR BUSTILLO DDS, MS

Provider Business Mailing Address
First Line	:	11936 BOYETTE RD
Second Line	:
City	:	RIVERVIEW
State	:	FL
Zip	:	33569-5601
Country	:	US
Telephone Number	:	813-672-3368
Fax Number	:

Provider Business Practice Location Address
First Line	:	11936 BOYETTE RD
Second Line	:
City	:	RIVERVIEW
State	:	FL
Zip	:	33569-5601
Country	:	US
Telephone Number	:	813-672-3368
Fax Number	:

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

Provider Enumeration Date	:	12/20/2006
Last Update Date	:	05/11/2016

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