MEDICARE: DR. ROGER JOSEPH PHANORD D.M.D.

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	DN0011339	FL

General Provider Information

NPI Number	:	1265505515
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROGER JOSEPH PHANORD D.M.D.

Provider Business Mailing Address
First Line	:	5337 NE 2ND AVE
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33137-2707
Country	:	US
Telephone Number	:	305-758-0815
Fax Number	:	305-758-5030

Provider Business Practice Location Address
First Line	:	5337 NE 2ND AVE
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33137-2707
Country	:	US
Telephone Number	:	305-758-0815
Fax Number	:	305-758-5030

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

Provider Enumeration Date	:	11/16/2006
Last Update Date	:	07/09/2007

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