MEDICARE: DR. ADAM W MARCHESE 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	1223G0001X	General Practice Dentistry	DN17179	FL

General Provider Information

NPI Number	:	1205915659
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ADAM W MARCHESE DMD

Provider Business Mailing Address
First Line	:	315 W CALL ST
Second Line	:
City	:	STARKE
State	:	FL
Zip	:	32091-3113
Country	:	US
Telephone Number	:	904-964-7501
Fax Number	:	904-964-7503

Provider Business Practice Location Address
First Line	:	315 W CALL ST
Second Line	:
City	:	STARKE
State	:	FL
Zip	:	32091-3113
Country	:	US
Telephone Number	:	904-964-7501
Fax Number	:	904-964-7503

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

Provider Enumeration Date	:	11/06/2006
Last Update Date	:	07/08/2007

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