MEDICARE: DR. SERGEY KOROL D.M.D.

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	DN15197	FL

General Provider Information

NPI Number	:	1174726921
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SERGEY KOROL D.M.D.

Provider Business Mailing Address
First Line	:	2315 S DIXIE HWY
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33401-7913
Country	:	US
Telephone Number	:	561-833-1042
Fax Number	:	561-659-5037

Provider Business Practice Location Address
First Line	:	2315 S DIXIE HWY
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33401-7913
Country	:	US
Telephone Number	:	561-833-1042
Fax Number	:	561-659-5037

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

Provider Enumeration Date	:	06/08/2007
Last Update Date	:	07/17/2007

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