MEDICARE: DR. ROBERT ALAN DEMICK 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	1223S0112X	Oral and Maxillofacial Surgery (Dentist)	DL9191	FL

General Provider Information

NPI Number	:	1366699597
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROBERT ALAN DEMICK DDS

Provider Business Mailing Address
First Line	:	8320 W SUNRISE BLVD STE 106
Second Line	:
City	:	PLANTATION
State	:	FL
Zip	:	33322-5434
Country	:	US
Telephone Number	:	954-396-6800
Fax Number	:

Provider Business Practice Location Address
First Line	:	8320 W SUNRISE BLVD STE 106
Second Line	:
City	:	PLANTATION
State	:	FL
Zip	:	33322-5434
Country	:	US
Telephone Number	:	954-396-6800
Fax Number	:

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

Provider Enumeration Date	:	08/19/2008
Last Update Date	:	08/19/2008

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