MEDICARE: A. PRYOR VANOVERBEKE

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	261QD0000X	Dental Clinic/Center	DN 14679	FL

General Provider Information

NPI Number	:	1215195581
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	A. PRYOR VANOVERBEKE

Provider Business Mailing Address
First Line	:	5518 HANLEY RD
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33634-4904
Country	:	US
Telephone Number	:	813-884-1419
Fax Number	:	813-884-1501

Provider Business Practice Location Address
First Line	:	5518 HANLEY RD
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33634-4904
Country	:	US
Telephone Number	:	813-884-1419
Fax Number	:	813-884-1501

Authorized Official
Title or Position	:	DENTIST
Name	:	ALLEN PRYOR VANOVERBEKE II
Credential	:	D.M.D.
Telephone Number	:	813-884-1419

Provider Enumeration Date	:	05/23/2008
Last Update Date	:	05/23/2008

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Directions to “A. PRYOR VANOVERBEKE ” Practice Location

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