MEDICARE: CARLY SIGNORELLI 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	64842	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1134546534
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CARLY SIGNORELLI DMD

Provider Business Mailing Address
First Line	:	400 ANZA ST APT 403
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94118-4389
Country	:	US
Telephone Number	:	954-461-7899
Fax Number	:

Provider Business Practice Location Address
First Line	:	37944 CHURCH AVE
Second Line	:
City	:	DADE CITY
State	:	FL
Zip	:	33525-4207
Country	:	US
Telephone Number	:	352-518-2000
Fax Number	:

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

Provider Enumeration Date	:	03/24/2014
Last Update Date	:	05/06/2022

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