MEDICARE: JOHN D DOS PASSOS II DMD PA

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	12680	FL

General Provider Information

NPI Number	:	1417962077
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JOHN D DOS PASSOS II DMD PA

Provider Business Mailing Address
First Line	:	6552 GUNN HWY
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33625-4022
Country	:	US
Telephone Number	:	813-963-0307
Fax Number	:	813-968-3210

Provider Business Practice Location Address
First Line	:	6552 GUNN HWY
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33625-4022
Country	:	US
Telephone Number	:	813-963-0307
Fax Number	:	813-968-3210

Authorized Official
Title or Position	:	OWNER/DENTIST
Name	:	JOHN DAVID DOS PASSOS II
Credential	:	DMD
Telephone Number	:	813-963-0307

Provider Enumeration Date	:	07/30/2006
Last Update Date	:	05/17/2010

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