MEDICARE: DR. ROBERT GARY VICTOME DDS

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	DN13708	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	650670857	OTHER	FL	TAX ID
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1437238516
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROBERT GARY VICTOME DDS

Provider Business Mailing Address
First Line	:	6137 LAKE WORTH RD
Second Line	:
City	:	GREENACRES
State	:	FL
Zip	:	33463-3074
Country	:	US
Telephone Number	:	561-357-1009
Fax Number	:	561-969-7624

Provider Business Practice Location Address
First Line	:	6137 LAKE WORTH RD
Second Line	:
City	:	GREENACRES
State	:	FL
Zip	:	33463-3074
Country	:	US
Telephone Number	:	561-357-1009
Fax Number	:	561-969-7624

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

Provider Enumeration Date	:	11/02/2006
Last Update Date	:	10/13/2016

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