MEDICARE: DR. MARK LYLE OBMAN D.D.S.

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	DN-0014471	FL

General Provider Information

NPI Number	:	1285660019
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARK LYLE OBMAN D.D.S.

Provider Business Mailing Address
First Line	:	2708 PARK DR
Second Line	:
City	:	CLEARWATER
State	:	FL
Zip	:	33763-1020
Country	:	US
Telephone Number	:	727-796-1767
Fax Number	:	727-791-4831

Provider Business Practice Location Address
First Line	:	2708 PARK DR
Second Line	:
City	:	CLEARWATER
State	:	FL
Zip	:	33763-1020
Country	:	US
Telephone Number	:	727-796-1767
Fax Number	:	727-791-4831

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

Provider Enumeration Date	:	06/23/2006
Last Update Date	:	07/08/2007

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