MEDICARE: DR. DAVID RICHARD OLINZOCK 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	1223G0001X	General Practice Dentistry	DN 14473	FL

General Provider Information

NPI Number	:	1396748117
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DAVID RICHARD OLINZOCK D.D.S.

Provider Business Mailing Address
First Line	:	455 20TH ST
Second Line	:
City	:	ATLANTIC BEACH
State	:	FL
Zip	:	32233-4546
Country	:	US
Telephone Number	:	904-241-3194
Fax Number	:

Provider Business Practice Location Address
First Line	:	12620 BEACH BLVD
Second Line	:	STE 18
City	:	JACKSONVILLE
State	:	FL
Zip	:	32246-7130
Country	:	US
Telephone Number	:	904-620-0404
Fax Number	:	904-620-0445

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

Provider Enumeration Date	:	05/24/2005
Last Update Date	:	07/08/2007

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