MEDICARE: DR. JEFFREY THOMAS TOMAMICHEL 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	12083	FL

General Provider Information

NPI Number	:	1164446092
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JEFFREY THOMAS TOMAMICHEL D.D.S.

Provider Business Mailing Address
First Line	:	3984 3RD ST S
Second Line	:
City	:	JACKSONVILLE BEACH
State	:	FL
Zip	:	32250-5847
Country	:	US
Telephone Number	:	904-241-3909
Fax Number	:

Provider Business Practice Location Address
First Line	:	3984 3RD ST S
Second Line	:
City	:	JACKSONVILLE BEACH
State	:	FL
Zip	:	32250-5847
Country	:	US
Telephone Number	:	904-241-3909
Fax Number	:	904-249-5234

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

Provider Enumeration Date	:	07/26/2006
Last Update Date	:	07/08/2007

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