MEDICARE: DR. MICHAEL GOFFREDO 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	DN8005	FL

General Provider Information

NPI Number	:	1306848429
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL GOFFREDO D.M.D.

Provider Business Mailing Address
First Line	:	21017 SHADY VISTA LN
Second Line	:
City	:	BOCA RATON
State	:	FL
Zip	:	33428-1185
Country	:	US
Telephone Number	:	561-483-5171
Fax Number	:

Provider Business Practice Location Address
First Line	:	23082 SANDALFOOT PLAZA DR
Second Line	:
City	:	BOCA RATON
State	:	FL
Zip	:	33428-6654
Country	:	US
Telephone Number	:	561-482-4111
Fax Number	:	561-482-4211

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

Provider Enumeration Date	:	06/01/2005
Last Update Date	:	03/03/2010

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