MEDICARE: WILLIAM SHORACK DDS

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	6456	FL

General Provider Information

NPI Number	:	1316031198
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WILLIAM SHORACK DDS

Provider Business Mailing Address
First Line	:	13432 PALM BEACH BLVD
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33905-2129
Country	:	US
Telephone Number	:	239-694-0834
Fax Number	:	239-694-7014

Provider Business Practice Location Address
First Line	:	13432 PALM BEACH BLVD
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33905-2129
Country	:	US
Telephone Number	:	239-694-0834
Fax Number	:	239-694-7014

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

Provider Enumeration Date	:	10/03/2006
Last Update Date	:	07/08/2007

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Directions to “ WILLIAM SHORACK DDS” Practice Location

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