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NPI Code Detail

MEDICARE: GARY MICHAEL LEASE DMD

MEDICARE: GARY MICHAEL LEASE DMD
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
1122300000XDentistDN13231FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1316945751
Entity Type Code : Individual
Provider Name (Legal Business Name) : GARY MICHAEL LEASE DMD
Provider Business Mailing Address
First Line : PO BOX 1249
Second Line :
City : APOPKA
State : FL
Zip : 32704-1249
Country : US
Telephone Number : 407-905-8827
Fax Number : 407-905-8998
Provider Business Practice Location Address
First Line : 1296 W BROAD ST
Second Line :
City : GROVELAND
State : FL
Zip : 34736-2012
Country : US
Telephone Number : 407-905-8827
Fax Number : 352-429-1257
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/11/2005
Last Update Date : 08/18/2011

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Directions to “ GARY MICHAEL LEASE DMD” Practice Location

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