MEDICARE: DR. BRIAN F VESTAL 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 17713	FL

General Provider Information

NPI Number	:	1396912564
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BRIAN F VESTAL D.D.S.

Provider Business Mailing Address
First Line	:	200 PASADENA AVE S
Second Line	:
City	:	ST PETERSBURG
State	:	FL
Zip	:	33707-1251
Country	:	US
Telephone Number	:	727-347-1214
Fax Number	:	727-302-0401

Provider Business Practice Location Address
First Line	:	200 PASADENA AVE S
Second Line	:
City	:	ST PETERSBURG
State	:	FL
Zip	:	33707-1251
Country	:	US
Telephone Number	:	727-347-1214
Fax Number	:	727-302-0401

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

Provider Enumeration Date	:	05/15/2008
Last Update Date	:	05/15/2008

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