MEDICARE: DR. MICHAEL EMMANOUL GAGAOUDAKIS 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	1223G0001X	General Practice Dentistry	DN17757	FL

General Provider Information

NPI Number	:	1326188038
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL EMMANOUL GAGAOUDAKIS D.M.D.

Provider Business Mailing Address
First Line	:	311 LIGHTHOUSE COVE CT
Second Line	:	103
City	:	OCOEE
State	:	FL
Zip	:	34761-4833
Country	:	US
Telephone Number	:	954-830-0030
Fax Number	:

Provider Business Practice Location Address
First Line	:	6000 TURKEY LAKE RD
Second Line	:	#109
City	:	ORLANDO
State	:	FL
Zip	:	32819-4200
Country	:	US
Telephone Number	:	407-547-6453
Fax Number	:

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

Provider Enumeration Date	:	02/08/2007
Last Update Date	:	03/31/2017

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