MEDICARE: CRAIG M HESCHELES 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	1223P0300X	Periodontics	DN14588	FL

General Provider Information

NPI Number	:	1205140407
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CRAIG M HESCHELES DMD

Provider Business Mailing Address
First Line	:	8190 JOG RD
Second Line	:	SUITE 210
City	:	BOYNTON BEACH
State	:	FL
Zip	:	33472-2912
Country	:	US
Telephone Number	:	561-752-8640
Fax Number	:

Provider Business Practice Location Address
First Line	:	8190 JOG RD
Second Line	:	SUITE 210
City	:	BOYNTON BEACH
State	:	FL
Zip	:	33472-2912
Country	:	US
Telephone Number	:	561-752-8640
Fax Number	:

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

Provider Enumeration Date	:	07/29/2010
Last Update Date	:	07/29/2010

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