MEDICARE: MILLS PARK 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	1223G0001X	General Practice Dentistry	DN16580	FL

Other Identifiers

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

General Provider Information

NPI Number	:	1356745178
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MILLS PARK DENTAL

Provider Business Mailing Address
First Line	:	1327 N MILLS AVE
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32803-2542
Country	:	US
Telephone Number	:	407-228-1353
Fax Number	:	407-228-1394

Provider Business Practice Location Address
First Line	:	1327 N MILLS AVE
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32803-2542
Country	:	US
Telephone Number	:	407-228-1353
Fax Number	:	407-228-1394

Authorized Official
Title or Position	:	DENTIST
Name	:	DR. ANNE MURUGASU-REID
Credential	:	DDS
Telephone Number	:	407-228-1353

Provider Enumeration Date	:	10/22/2014
Last Update Date	:	10/22/2014

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Directions to “MILLS PARK DENTAL ” Practice Location

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