MEDICARE: FLORIDA DENTAL PROFESSIONALS, P.A.

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

General Provider Information

NPI Number	:	1225571532
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FLORIDA DENTAL PROFESSIONALS, P.A.

Provider Business Mailing Address
First Line	:	35691 US 19 N
Second Line	:
City	:	PALM HARBOR
State	:	FL
Zip	:	34684-1739
Country	:	US
Telephone Number	:	727-785-8017
Fax Number	:

Provider Business Practice Location Address
First Line	:	35691 US 19 N
Second Line	:
City	:	PALM HARBOR
State	:	FL
Zip	:	34684-1739
Country	:	US
Telephone Number	:	727-785-8017
Fax Number	:

Authorized Official
Title or Position	:	CREDENTIALING COORDINATOR
Name	:	CASSANDRA TEUTSCH
Credential	:
Telephone Number	:	217-540-8972

Provider Enumeration Date	:	11/18/2016
Last Update Date	:	11/18/2016

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