MEDICARE: MICHAEL A. PIKOS D.D.S.

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	1223S0112X	Oral and Maxillofacial Surgery (Dentist)	DN0009294	FL

General Provider Information

NPI Number	:	1346239340
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL A. PIKOS D.D.S.

Provider Business Mailing Address
First Line	:	2711 TAMPA RD
Second Line	:
City	:	PALM HARBOR
State	:	FL
Zip	:	34684-3312
Country	:	US
Telephone Number	:	727-786-1631
Fax Number	:	727-785-8477

Provider Business Practice Location Address
First Line	:	2711 TAMPA RD
Second Line	:
City	:	PALM HARBOR
State	:	FL
Zip	:	34684-3312
Country	:	US
Telephone Number	:	727-786-1631
Fax Number	:	727-785-8477

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

Provider Enumeration Date	:	10/21/2005
Last Update Date	:	07/08/2007

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