MEDICARE: MARTIN R CIRULIS 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	1223G0001X	General Practice Dentistry	2091010786	MI

General Provider Information

NPI Number	:	1326235193
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARTIN R CIRULIS DDS

Provider Business Mailing Address
First Line	:	320 LONG RAPIDS PLZ
Second Line	:
City	:	ALPENA
State	:	MI
Zip	:	49707-1374
Country	:	US
Telephone Number	:	989-354-2108
Fax Number	:

Provider Business Practice Location Address
First Line	:	320 LONG RAPIDS PLZ
Second Line	:
City	:	ALPENA
State	:	MI
Zip	:	49707-1374
Country	:	US
Telephone Number	:	989-354-2108
Fax Number	:

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

Provider Enumeration Date	:	09/26/2007
Last Update Date	:	09/26/2007

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