MEDICARE: DR. ROBERT ERDMAN DDS PA

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	11444	FL

General Provider Information

NPI Number	:	1316003882
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROBERT ERDMAN DDS PA

Provider Business Mailing Address
First Line	:	2578 S VOLUSIA AVE
Second Line	:
City	:	ORANGE CITY
State	:	FL
Zip	:	32763-9124
Country	:	US
Telephone Number	:	386-775-1552
Fax Number	:	386-775-1312

Provider Business Practice Location Address
First Line	:	2578 S VOLUSIA AVE
Second Line	:
City	:	ORANGE CITY
State	:	FL
Zip	:	32763-9124
Country	:	US
Telephone Number	:	386-775-1552
Fax Number	:	386-775-1312

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

Provider Enumeration Date	:	12/29/2006
Last Update Date	:	07/08/2007

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