MEDICARE: MIL-LAKE DENTAL

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	DN13708	FL
2	152W00000X	Optometrist
3	156FX1800X	Optician		FL
4	207W00000X	Ophthalmology Physician
5	208D00000X	General Practice Physician

General Provider Information

NPI Number	:	1346798063
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MIL-LAKE DENTAL

Provider Business Mailing Address
First Line	:	6137 LAKE WORTH RD
Second Line	:
City	:	GREENACRES
State	:	FL
Zip	:	33463-3074
Country	:	US
Telephone Number	:	561-357-1009
Fax Number	:	561-969-7624

Provider Business Practice Location Address
First Line	:	7657 LAKE WORTH RD
Second Line	:
City	:	LAKE WORTH
State	:	FL
Zip	:	33467-2534
Country	:	US
Telephone Number	:	561-357-1009
Fax Number	:	561-969-7624

Authorized Official
Title or Position	:	OWNER
Name	:	DR. ROBERT G. VICTOME
Credential	:	DDS
Telephone Number	:	561-357-1009

Provider Enumeration Date	:	09/12/2016
Last Update Date	:	10/20/2016

Similar Medicare Providers

1740243260 — CONCEPT WEST EFL IMAGING CENTER LLC
Practice Location Address:

7639 LAKE WORTH RD
LAKE WORTH, FL
33467-2534

Practice Phone: 561-966-6288
Practice Fax: 561-966-6765

1689725533 — RONALD G. KLUDO D.O.
Practice Location Address:

7653 LAKE WORTH RD
LAKE WORTH, FL
33467-2534

Practice Phone: 561-434-9066
Practice Fax: 561-434-0222

1053433144 — DR. BRUCE STANLEY ZELAZEK DDS
Practice Location Address:

7689 LAKE WORTH RD
LAKE WORTH, FL
33467-2534

Practice Phone: 561-966-5577
Practice Fax:

1255880068 — JEAN R DUMONT
Practice Location Address:

7657 LAKE WORTH RD
LAKE WORTH, FL
33467-2534

Practice Phone: 561-432-4141
Practice Fax:

1366984155 — CENTAURUS HEALTHCARE, INCORPORATED
Practice Location Address:

7657 LAKE WORTH RD
LAKE WORTH, FL
33467-2534

Practice Phone: 561-357-1009
Practice Fax:

1780292359 — GEMINI AMBULATORY SURGICAL CENTER INCORPORATED
Practice Location Address:

7661 LAKE WORTH RD
LAKE WORTH, FL
33467-2534

Practice Phone: 561-432-4141
Practice Fax:

Directions to “MIL-LAKE DENTAL ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2025 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.