MEDICARE: VDC-TRINITY 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	DN17567	FL
2	1223G0001X	General Practice Dentistry	DN17081	FL
3	1223G0001X	General Practice Dentistry	DN7162	FL

General Provider Information

NPI Number	:	1427320191
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VDC-TRINITY PA

Provider Business Mailing Address
First Line	:	4122 ROWAN RD
Second Line	:
City	:	NEW PORT RICHEY
State	:	FL
Zip	:	34653-6122
Country	:	US
Telephone Number	:	727-372-0100
Fax Number	:	727-372-2345

Provider Business Practice Location Address
First Line	:	4122 ROWAN RD
Second Line	:
City	:	NEW PORT RICHEY
State	:	FL
Zip	:	34653-6122
Country	:	US
Telephone Number	:	352-684-1274
Fax Number	:	352-263-2756

Authorized Official
Title or Position	:	MANGER
Name	:	MRS. JANEEN M GORMAN
Credential	:
Telephone Number	:	352-684-1274

Provider Enumeration Date	:	01/27/2012
Last Update Date	:	02/16/2012

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Directions to “VDC-TRINITY PA ” Practice Location

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