MEDICARE: CHARLES A. SARLO JR. D.D.S., 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	1223S0112X	Oral and Maxillofacial Surgery (Dentist)	9520	FL

General Provider Information

NPI Number	:	1285792986
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHARLES A. SARLO JR. D.D.S., P.A.

Provider Business Mailing Address
First Line	:	5201 BABCOCK ST NE STE 8
Second Line	:
City	:	PALM BAY
State	:	FL
Zip	:	32905-4637
Country	:	US
Telephone Number	:	321-984-2565
Fax Number	:	321-984-2926

Provider Business Practice Location Address
First Line	:	5201 BABCOCK ST NE STE 8
Second Line	:
City	:	PALM BAY
State	:	FL
Zip	:	32905-4637
Country	:	US
Telephone Number	:	321-984-2565
Fax Number	:	321-984-2926

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

Provider Enumeration Date	:	12/05/2006
Last Update Date	:	07/08/2007

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Directions to “ CHARLES A. SARLO JR. D.D.S., P.A.” Practice Location

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