MEDICARE: BARAK DENTAL GROUP

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	DN9771	FL

General Provider Information

NPI Number	:	1184069064
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BARAK DENTAL GROUP

Provider Business Mailing Address
First Line	:	2608 PIONEER RD
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32808
Country	:	US
Telephone Number	:	407-299-3232
Fax Number	:

Provider Business Practice Location Address
First Line	:	2608 PIONEER RD
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32808-3221
Country	:	US
Telephone Number	:	407-299-3232
Fax Number	:

Authorized Official
Title or Position	:	DENTIST
Name	:	DR. JANICE SISTRUNK- CARLTON
Credential	:	DDS
Telephone Number	:	407-299-3232

Provider Enumeration Date	:	05/06/2013
Last Update Date	:	05/06/2013

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Directions to “BARAK DENTAL GROUP ” Practice Location

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