MEDICARE: ANASTASI JOHN ROUPAS DMD

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	6304	NC

General Provider Information

NPI Number	:	1386636462
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANASTASI JOHN ROUPAS DMD

Provider Business Mailing Address
First Line	:	7128 LAWYERS RD
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28227-3906
Country	:	US
Telephone Number	:	704-568-8010
Fax Number	:	704-563-0496

Provider Business Practice Location Address
First Line	:	7128 LAWYERS RD
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28227-3906
Country	:	US
Telephone Number	:	704-568-8010
Fax Number	:	704-563-0496

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

Provider Enumeration Date	:	08/16/2005
Last Update Date	:	07/08/2007

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