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NPI Code Detail

MEDICARE: CITRUS DENTAL OF INVERNESS, P.A.

MEDICARE: CITRUS DENTAL OF INVERNESS, P.A.
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
11223G0001XGeneral Practice Dentistry5731FL

General Provider Information

NPI Number : 1164712881
Entity Type Code : Organization
Provider Name (Legal Business Name) : CITRUS DENTAL OF INVERNESS, P.A.
Provider Business Mailing Address
First Line : 2231 HIGHWAY 44 W
Second Line : UNIT 101
City : INVERNESS
State : FL
Zip : 34453-3879
Country : US
Telephone Number : 352-726-5854
Fax Number : 352-726-6893
Provider Business Practice Location Address
First Line : 2231 HIGHWAY 44 W
Second Line : UNIT 101
City : INVERNESS
State : FL
Zip : 34453-3879
Country : US
Telephone Number : 352-726-5854
Fax Number : 352-726-6893
Authorized Official
Title or Position : OWNER
Name : DR. EDWIN HOLLAND
Credential : D.D.S.
Telephone Number : 352-726-5854
Provider Enumeration Date : 04/14/2011
Last Update Date : 04/14/2011

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